MEDICARE: KURTIS ALAN CAMPBELL M.D.

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	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	D39104	MD
2	2086S0102X	Surgical Critical Care Physician	D39104	MD
3	2086X0206X	Surgical Oncology Physician	D0039104	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1765510	OTHER	MD	AETNA HMO
2	0002	OTHER	DC	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4501907	OTHER	MD	AETNA
5	BCBS	OTHER	MD	52828905

General Provider Information

NPI Number	:	1740248004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURTIS ALAN CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 64475
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4475
Country	:	US
Telephone Number	:	443-481-6566
Fax Number	:	443-481-6515

Provider Business Practice Location Address
First Line	:	2003 MEDICAL PKWY
Second Line	:	SUITE 301
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7992
Country	:	US
Telephone Number	:	443-481-3717
Fax Number	:	443-481-3730

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/31/2012

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