Healthcare Provider Details

I. General information

NPI: 1255823209
Provider Name (Legal Business Name): DOMINIC CAMPANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 BOWMAN GRAY DR
GREENVILLE NC
27834-7286
US

IV. Provider business mailing address

503 BOWMAN GRAY DR
GREENVILLE NC
27834-7286
US

V. Phone/Fax

Practice location:
  • Phone: 252-816-4001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number123456789
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10067229
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2024-022
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: