1215045638 NPI number — DR. KIMBERLY MARIE CAMPBELL-ARRENDELL MD

Table of content: DR. KIMBERLY MARIE CAMPBELL-ARRENDELL MD (NPI 1215045638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215045638 NPI number — DR. KIMBERLY MARIE CAMPBELL-ARRENDELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL-ARRENDELL
Provider First Name:
KIMBERLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215045638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 GALLOWS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-776-4001
Provider Business Mailing Address Fax Number:
703-776-7113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GALLOWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-776-4001
Provider Business Practice Location Address Fax Number:
703-776-7113
Provider Enumeration Date:
08/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D0050472 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 0101233104 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08202 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 362381501 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 534928-06 . This is a "BC/BSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BC/BSDC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0701195 . This is a "UHC COMM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100722 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4526432 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 502039 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 462201 . This is a "ANTHEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2995268 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 633471 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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