Healthcare Provider Details

I. General information

NPI: 1225001035
Provider Name (Legal Business Name): BRIAN CAMPBELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 PARRISH ST
CANANDAIGUA NY
14424-1728
US

IV. Provider business mailing address

335 PARRISH ST
CANANDAIGUA NY
14424-1728
US

V. Phone/Fax

Practice location:
  • Phone: 585-393-2888
  • Fax: 585-396-9275
Mailing address:
  • Phone: 585-393-2888
  • Fax: 585-396-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: