Provider Demographics
NPI:1376519421
Name:ROBERTS, CAMILLE IVAH (MD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:IVAH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:405 GROVE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1270
Mailing Address - Country:US
Mailing Address - Phone:508-890-5500
Mailing Address - Fax:508-890-5505
Practice Address - Street 1:175 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6951
Practice Address - Country:US
Practice Address - Phone:336-718-1006
Practice Address - Fax:336-718-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2025-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA223309207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2101513Medicaid
470259OtherTUFTS HEALTH PLAN
J28697OtherBLUE CROSS ELECT
042472266OtherUNITED HEALTHCARE
042472266OtherTHREE RIVERS
87361OtherCHILDRENS MEDICAL SECURIT
J28697OtherBLUE SHIELD INDEMNITY
2101513OtherMEDICAID WELFARE
2283928OtherFIRST HEALTH
92299OtherFALLON COMMUNITY HEALTH
042472266OtherTRICARE CHAMPUS
AA30837OtherHARVARD PILGRIM HEALTHCAR
J28697OtherBLUE SHIELD HMO BLUE
1212746OtherCIGNA HEALTH PLAN
7668645OtherAETNA US HEALTHCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
87361OtherHEALTHY START
787925OtherMVP HEALTH CARE
042472266OtherUNITED HEALTHCARE
787925OtherMVP HEALTH CARE