Healthcare Provider Details

I. General information

NPI: 1851511349
Provider Name (Legal Business Name): RICHARD A CAMPBELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 HAVERHILL ST
ANDOVER MA
01810-1509
US

IV. Provider business mailing address

PO BOX 9132
BROOKLINE MA
02446-9132
US

V. Phone/Fax

Practice location:
  • Phone: 978-296-2302
  • Fax: 978-296-2304
Mailing address:
  • Phone: 603-893-9784
  • Fax: 603-893-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number252209
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: