Healthcare Provider Details

I. General information

NPI: 1841379658
Provider Name (Legal Business Name): VANESSA A CAMPERLENGO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 PETER JEFFERSON PARKWAY SUITE 335
CHARLOTTESVILLE VA
22911-8618
US

IV. Provider business mailing address

675 PETER JEFFERSON PARKWAY SUITE 335
CHARLOTTESVILLE VA
22911-8618
US

V. Phone/Fax

Practice location:
  • Phone: 434-975-4440
  • Fax: 434-975-5551
Mailing address:
  • Phone: 434-975-4440
  • Fax: 434-975-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101044562
License Number State

VIII. Authorized Official

Name: VANESSA ANDREA CAMPERLENGO
Title or Position: PRESIDENT
Credential: MD
Phone: 434-975-4440