Basic Information
| Provider Information | |||||||||
| NPI: | 1902366602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUDETTE | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 CHESTNUT ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011051442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137942515 | ||||||||
| FaxNumber: | 4137945673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2019 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 292331 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | 292331 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.