MEDICARE: DR. DOUGLAS E 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	NOO5147	NY

General Provider Information

NPI Number	:	1366442360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS E CAMPBELL DPM

Provider Business Mailing Address
First Line	:	4626 NEW UTRECHT AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2554
Country	:	US
Telephone Number	:	718-853-7469
Fax Number	:	718-972-7679

Provider Business Practice Location Address
First Line	:	4626 NEW UTRECHT AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2554
Country	:	US
Telephone Number	:	718-853-7469
Fax Number	:	718-972-7679

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	02/15/2024

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