Healthcare Provider Details

I. General information

NPI: 1659457844
Provider Name (Legal Business Name): RUTH ELIZABETH CAMPBELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH ELIZABETH PINKNEY

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/12/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EASTERN CORRECTIONAL INSTITUTION 30420 REVELLS NECK RD
WESTOVER MD
21890
US

IV. Provider business mailing address

EASTERN CORRECTIONAL INSTITUTION 30420 REVELLS NECK RD
WESTOVER MD
21890
US

V. Phone/Fax

Practice location:
  • Phone: 410-845-4000
  • Fax: 410-845-4134
Mailing address:
  • Phone: 410-845-4000
  • Fax: 410-845-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: