Healthcare Provider Details

I. General information

NPI: 1043839467
Provider Name (Legal Business Name): TIMOTHY DOUGLAS CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST STE 500
TOWSON MD
21204-5832
US

IV. Provider business mailing address

48 E HENRIETTA RD
ROCHESTER NY
14620-4236
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-5454
  • Fax: 410-825-6320
Mailing address:
  • Phone: 847-890-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0104661
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: