1063477446 NPI number — DAVID CAMPBELL

Table of content: (NPI 1063477446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063477446 NPI number — DAVID CAMPBELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID CAMPBELL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063477446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 86
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02043-0086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-749-9071
Provider Business Mailing Address Fax Number:
781-749-2133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 FRANCIS ST
Provider Second Line Business Practice Location Address:
SUITE 5C
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-9848
Provider Business Practice Location Address Fax Number:
617-632-7794
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
617-632-9848

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  39971 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0092648 . This is a "AE/US" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A27717BI . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0194964 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030545 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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