Provider Demographics
NPI:1184782070
Name:SALAME, CAMILLE G (MD, MS)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:G
Last Name:SALAME
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 TOWNE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2247
Mailing Address - Country:US
Mailing Address - Phone:860-889-8598
Mailing Address - Fax:860-889-5427
Practice Address - Street 1:1 TOWNE PARK PLZ
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2247
Practice Address - Country:US
Practice Address - Phone:860-889-8598
Practice Address - Fax:860-889-5427
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032052207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010032052CT01OtherANTHEM
CT001320522Medicaid
CT010032052CT01OtherANTHEM
CTD400000297Medicare PIN