Healthcare Provider Details

I. General information

NPI: 1053511352
Provider Name (Legal Business Name): MARIE CELESTE CAMPAGNONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6261 EXECUTIVE BLVD
ROCKVILLE MD
20852-3906
US

IV. Provider business mailing address

6261 EXECUTIVE BLVD
ROCKVILLE MD
20852-3906
US

V. Phone/Fax

Practice location:
  • Phone: 301-948-0454
  • Fax: 301-770-4670
Mailing address:
  • Phone: 301-948-0454
  • Fax: 301-770-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD52438
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: