Provider Demographics
NPI:1063088730
Name:FLETCHER, CAMERON ROBERT I (PA)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ROBERT
Last Name:FLETCHER
Suffix:I
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-738-7015
Mailing Address - Fax:401-738-0013
Practice Address - Street 1:455 TOLL GATE ROAD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-737-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2023-02-17
Deactivation Date:2021-09-25
Deactivation Code:
Reactivation Date:2021-10-14
Provider Licenses
StateLicense IDTaxonomies
RIPA01358363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant