Healthcare Provider Details

I. General information

NPI: 1497755425
Provider Name (Legal Business Name): PHYLLIS E CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR SUITE 200
COLUMBIA MD
21044-3128
US

IV. Provider business mailing address

10710 CHARTER DR SUITE 200
COLUMBIA MD
21044-3128
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-0580
  • Fax: 410-740-8587
Mailing address:
  • Phone: 410-997-0580
  • Fax: 410-740-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD33911
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: