Healthcare Provider Details

I. General information

NPI: 1740248004
Provider Name (Legal Business Name): KURTIS ALAN CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY SUITE 301
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

PO BOX 64475
BALTIMORE MD
21264-4475
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-3717
  • Fax: 443-481-3730
Mailing address:
  • Phone: 443-481-6566
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD39104
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD39104
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberD0039104
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: