Healthcare Provider Details

I. General information

NPI: 1679772909
Provider Name (Legal Business Name): KARLA MAE CAMPANELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLA MAE ONEST

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 BUTLER RD
MOUNT GRETNA PA
17064-6085
US

IV. Provider business mailing address

PO BOX 550
MOUNT GRETNA PA
17064-0550
US

V. Phone/Fax

Practice location:
  • Phone: 717-279-2791
  • Fax:
Mailing address:
  • Phone: 717-279-2791
  • Fax: 717-279-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD054321L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: