Healthcare Provider Details

I. General information

NPI: 1427213636
Provider Name (Legal Business Name): JOHN E CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 09/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WASHINGTON ST E
CHARLESTON WV
25301-1834
US

IV. Provider business mailing address

PO BOX 7000
MORGANTOWN WV
26507-7000
US

V. Phone/Fax

Practice location:
  • Phone: 304-347-1296
  • Fax: 304-347-1394
Mailing address:
  • Phone: 304-293-5033
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22654
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number22654
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: