Healthcare Provider Details

I. General information

NPI: 1679521041
Provider Name (Legal Business Name): THOMAS M CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHARPE ST
KINGSTON PA
18704-3715
US

IV. Provider business mailing address

2 SHARPE ST
KINGSTON PA
18704-3715
US

V. Phone/Fax

Practice location:
  • Phone: 570-552-8900
  • Fax: 570-552-8958
Mailing address:
  • Phone: 570-552-8900
  • Fax: 570-552-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS003748L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: