Healthcare Provider Details

I. General information

NPI: 1053004077
Provider Name (Legal Business Name): COURTNEY OSMOND CAMPBELL CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4750
  • Fax: 202-715-4759
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: