Healthcare Provider Details

I. General information

NPI: 1467552380
Provider Name (Legal Business Name): ETHEL CABRINA CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: E CABRINA CAMPBELL MD

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST 4TH FLOOR
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

800 SPRUCE ST 4TH FLOOR
PHILADELPHIA PA
19107-6130
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3474
  • Fax: 215-829-5456
Mailing address:
  • Phone: 215-829-3474
  • Fax: 215-829-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD046039L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: