1710986682 NPI number — TODD C CAMPBELL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710986682 NPI number — TODD C CAMPBELL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CAMPBELL

Provider First Name:

TODD

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1710986682

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/16/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

880 CENTURY DRIVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MECHANICSBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17055

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-691-3235

Provider Business Mailing Address Fax Number:

717-691-3243

Provider First Line Business Practice Location Address:

880 CENTURY DRIVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MECHANICSBURG

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17055

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-691-3235

Provider Business Practice Location Address Fax Number:

717-691-3243

Provider Enumeration Date:

07/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  200300950 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208600000X , with the licence number: MD428316 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1015292910001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1250401 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30033052 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 37167 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 201093283 . This is a "GROUP TAX ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 101529291001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 10152929101 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7211833 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 891347V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 2702925000 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 83031939 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".