1316161904 NPI number — MS. KACI CAMERRON MADISON MA, CAADC, CAC-AD

Table of content: MS. KACI CAMERRON MADISON MA, CAADC, CAC-AD (NPI 1316161904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316161904 NPI number — MS. KACI CAMERRON MADISON MA, CAADC, CAC-AD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADISON
Provider First Name:
KACI
Provider Middle Name:
CAMERRON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CAADC, CAC-AD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316161904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30000 CORDREY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLSBORO
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-227-1320
Provider Business Mailing Address Fax Number:
302-227-1327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20576 COASTAL HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-227-1320
Provider Business Practice Location Address Fax Number:
302-227-1327
Provider Enumeration Date:
04/13/2007

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 276400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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