MEDICARE: KAREN CAMPBELL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	SC003080L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275520041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN CAMPBELL DPM

Provider Business Mailing Address
First Line	:	410 GLENN AVE
Second Line	:	SUITE 201
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1200
Country	:	US
Telephone Number	:	570-387-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 GLENN AVE
Second Line	:	SUITE 201
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1200
Country	:	US
Telephone Number	:	570-387-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	05/22/2008

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