Healthcare Provider Details

I. General information

NPI: 1376100834
Provider Name (Legal Business Name): STEWART M CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MORGAN CAMPBELL MD

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BROADWAY ST OFC 213
BOULDER CO
80304-4108
US

IV. Provider business mailing address

2401 BROADWAY ST OFC 213
BOULDER CO
80304-4108
US

V. Phone/Fax

Practice location:
  • Phone: 215-421-0046
  • Fax: 256-807-2454
Mailing address:
  • Phone: 215-421-0046
  • Fax: 256-807-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0075185
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD482802
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: