Healthcare Provider Details

I. General information

NPI: 1134042872
Provider Name (Legal Business Name): LEUL CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 E PRATT ST STE 560
BALTIMORE MD
21202-3558
US

IV. Provider business mailing address

405 E NORTH AVE
BALTIMORE MD
21202-5903
US

V. Phone/Fax

Practice location:
  • Phone: 410-525-5005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: