Individual
DR. CHARLES DANIEL CAMMOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 480-3439
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35.058892
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079379
—
OH
01
—
11392128
CAQH
OH
01
—
H165530
MEDICARE PTAN
OH
01
—
P01237649
MEDICARE RAILROAD
OH
Enumeration date
06/06/2006
Last updated
04/23/2021
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