Healthcare Provider Details

I. General information

NPI: 1073435483
Provider Name (Legal Business Name): CAMPBELL ACO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 CAMPBELL AVE STE 1
WEST HAVEN CT
06516-3789
US

IV. Provider business mailing address

755 CAMPBELL AVE STE 1
WEST HAVEN CT
06516-3789
US

V. Phone/Fax

Practice location:
  • Phone: 203-937-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANNA PERERA
Title or Position: CEO
Credential:
Phone: 203-937-1100