Healthcare Provider Details

I. General information

NPI: 1528041613
Provider Name (Legal Business Name): DWIGHT D CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7785 N STATE ST SUITE 120
LOWVILLE NY
13367-1229
US

IV. Provider business mailing address

PO BOX 2337
SYRACUSE NY
13220-2337
US

V. Phone/Fax

Practice location:
  • Phone: 315-376-5163
  • Fax: 315-376-0372
Mailing address:
  • Phone: 315-422-2933
  • Fax: 315-422-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number213337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: