Healthcare Provider Details

I. General information

NPI: 1114947934
Provider Name (Legal Business Name): PATRICIA ISABEL CAMPBELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT ST
KEENE NH
03431-1719
US

IV. Provider business mailing address

590 COURT ST
KEENE NH
03431-1719
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5454
  • Fax: 603-354-6667
Mailing address:
  • Phone: 603-354-5454
  • Fax: 603-354-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number9720
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30009776
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: