Provider Demographics
NPI:1780916619
Name:MARIE ADDLY CAMBRONNE MD PA
Entity type:Organization
Organization Name:MARIE ADDLY CAMBRONNE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARIE-ADDLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMBRONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-335-4000
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-1277
Mailing Address - Country:US
Mailing Address - Phone:772-335-4000
Mailing Address - Fax:
Practice Address - Street 1:1700 SE HILLMOOR DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7539
Practice Address - Country:US
Practice Address - Phone:772-335-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME991432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty