Provider Demographics
NPI:1528078847
Name:BUCHANAN, CAMILLA M (MD)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:M
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 3400
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-253-5600
Practice Address - Fax:757-253-0819
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528078847Medicaid
VAB09787Medicare UPIN
VA015846R53Medicare PIN
VAP00790305Medicare PIN