Healthcare Provider Details

I. General information

NPI: 1093100646
Provider Name (Legal Business Name): DOUGLAS D. CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST
PORTLAND ME
04102-3100
US

IV. Provider business mailing address

887 CONGRESS ST
PORTLAND ME
04102-3100
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-6368
  • Fax:
Mailing address:
  • Phone: 207-774-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberDR.0060093
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD23589
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number264348
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0060093
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD23589
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: