Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0101253936 | VA |
N | 2086S0129X | Vascular Surgeon | 20465 | NH |
NPI | 1114188455 |
---|---|
Provider Name | Marc Anthony Camacho |
First Address | Concord, NH 03301-2548 |
Second Address | Concord, NH 03301-2548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 12/08/2020 |