Healthcare Provider Details

I. General information

NPI: 1326217415
Provider Name (Legal Business Name): JOHN REXFORD CAMPBELL ATP, RET
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOWELL RD
SHAVERTOWN PA
18708-9642
US

IV. Provider business mailing address

315 HOWELL RD
SHAVERTOWN PA
18708-9642
US

V. Phone/Fax

Practice location:
  • Phone: 570-338-0128
  • Fax: 570-300-1808
Mailing address:
  • Phone: 570-300-1808
  • Fax: 570-300-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberATP,RET
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code246ZB0301X
TaxonomyBiomedical Engineer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: