Healthcare Provider Details

I. General information

NPI: 1750811964
Provider Name (Legal Business Name): KIRSTI ANNE CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 810
ALEXANDRIA VA
22304-1300
US

IV. Provider business mailing address

4660 KENMORE AVE STE 810
ALEXANDRIA VA
22304-1300
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-6677
  • Fax: 571-506-2446
Mailing address:
  • Phone: 571-570-1819
  • Fax: 571-506-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD210003160
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101288526
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0096822
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: