Healthcare Provider Details

I. General information

NPI: 1962451765
Provider Name (Legal Business Name): LEOPOLD G CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4346 STARKEY RD STE 1
ROANOKE VA
24018-0605
US

IV. Provider business mailing address

4730 SUSSEX CT APT G
ROANOKE VA
24018-2348
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8043
  • Fax: 540-772-8242
Mailing address:
  • Phone: 704-591-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101255209
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101255209
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: