Healthcare Provider Details

I. General information

NPI: 1811961220
Provider Name (Legal Business Name): CRAIG P CAMPANELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9358 WARREN HILL LN
SCOTTSVILLE VA
24590-4019
US

IV. Provider business mailing address

9358 WARREN HILL LN
SCOTTSVILLE VA
24590-4019
US

V. Phone/Fax

Practice location:
  • Phone: 434-286-7337
  • Fax:
Mailing address:
  • Phone: 434-286-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80054
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: