Healthcare Provider Details

I. General information

NPI: 1063477446
Provider Name (Legal Business Name): DAVID CAMPBELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANCIS ST SUITE 5C
BOSTON MA
02215-5501
US

IV. Provider business mailing address

PO BOX 86
HINGHAM MA
02043-0086
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-9848
  • Fax: 617-632-7794
Mailing address:
  • Phone: 781-749-9071
  • Fax: 781-749-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39971
License Number StateMA

VIII. Authorized Official

Name: DAVID R CAMPBELL
Title or Position: MD/OWNER
Credential: M.D.
Phone: 617-632-9848