1427536002 NPI number — DOROTHY LORRAINE CAMPBELL MA

Table of content: DOROTHY LORRAINE CAMPBELL MA (NPI 1427536002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427536002 NPI number — DOROTHY LORRAINE CAMPBELL MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
DOROTHY
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
LORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1427536002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10223 FALCON PINE BLVD APT 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32829-7382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-591-8568
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 N SEMORAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32807-3531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-275-8939
Provider Business Practice Location Address Fax Number:
407-826-1484
Provider Enumeration Date:
08/06/2018

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101YA0400X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".