Provider Demographics
NPI:1306874839
Name:DUFFY, CAMERON DEWAYNE (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:DEWAYNE
Last Name:DUFFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 JERRY CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1783
Mailing Address - Country:US
Mailing Address - Phone:304-262-8901
Mailing Address - Fax:
Practice Address - Street 1:37 VERONICA DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3756
Practice Address - Country:US
Practice Address - Phone:304-671-2582
Practice Address - Fax:724-660-4233
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19195207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000954023OtherBLUE CROSS/BLUE SHIELD
MD0135178 00Medicaid
WV1801943000Medicaid
WVP0216471OtherRAILROAD MEDICARE
MD0135178 00Medicaid
MD0135178 00Medicaid