Healthcare Provider Details

I. General information

NPI: 1447326293
Provider Name (Legal Business Name): CARMEN DAVID CAMPANELLI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 FLORAL VALE BLVD
YARDLEY PA
19067-5515
US

IV. Provider business mailing address

14 SHADOW LN
CHADDS FORD PA
19317-9334
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-6155
  • Fax: 215-860-0723
Mailing address:
  • Phone: 302-777-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberC10006811
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD430789
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC10006811
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD430789
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD430789
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC10006811
License Number StateDE
# 7
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberC10006811
License Number StateDE
# 8
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC10006811
License Number StateDE
# 9
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD430789
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD430789
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: