1407827256 NPI number — ALISON GILLMOR CAMERON MD

Table of content: ALISON GILLMOR CAMERON MD (NPI 1407827256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407827256 NPI number — ALISON GILLMOR CAMERON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMERON
Provider First Name:
ALISON
Provider Middle Name:
GILLMOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILLMOR
Provider Other First Name:
ALISON
Provider Other Middle Name:
BOGUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407827256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LAWRENCE & MEMORIAL HOSPITAL
Provider Second Line Business Mailing Address:
365 MONTAUK AVENUE
Provider Business Mailing Address City Name:
NEW LONDON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-596-7477
Provider Business Mailing Address Fax Number:
401-596-0821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LAWRENCE & MEMORIAL HOSPITAL
Provider Second Line Business Practice Location Address:
365 MONTAUK AVENUE
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-442-0711
Provider Business Practice Location Address Fax Number:
401-348-3792
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  11343 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: CTMD045895 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050373266 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003123932 . This is a "MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9003480 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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