Healthcare Provider Details

I. General information

NPI: 1144719683
Provider Name (Legal Business Name): JONATHAN MICHAEL CAMPBELL AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 PAGE HILL RD
BERLIN NH
03570-3542
US

IV. Provider business mailing address

15 RICE LN
BEDFORD NH
03110-4642
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-2200
  • Fax:
Mailing address:
  • Phone: 845-702-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: