Healthcare Provider Details

I. General information

NPI: 1669161139
Provider Name (Legal Business Name): DYLAN ALEXANDER CAMPBELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SLATE CREEK RD STE 106
GRUNDY VA
24614-6975
US

IV. Provider business mailing address

2374 LITTLE PRATER RD
GRUNDY VA
24614
US

V. Phone/Fax

Practice location:
  • Phone: 276-935-6444
  • Fax:
Mailing address:
  • Phone: 276-696-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102210282
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: