Healthcare Provider Details

I. General information

NPI: 1447253554
Provider Name (Legal Business Name): PETER CARL CAMPANELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PENN AVE
SINKING SPRING PA
19608-1174
US

IV. Provider business mailing address

3855 PENN AVE
SINKING SPRING PA
19608-1174
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-4552
  • Fax: 610-678-7007
Mailing address:
  • Phone: 610-678-4552
  • Fax: 610-678-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD057801L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: