Healthcare Provider Details

I. General information

NPI: 1306841952
Provider Name (Legal Business Name): MARK CHRISTOPHER CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOWARD AVE STE 106
ALTOONA PA
16601-4813
US

IV. Provider business mailing address

615 HOWARD AVE STE 106
ALTOONA PA
16601-4813
US

V. Phone/Fax

Practice location:
  • Phone: 814-949-2950
  • Fax: 814-949-2960
Mailing address:
  • Phone: 814-949-2950
  • Fax: 814-949-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD419670
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: