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General NPI Number Information
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NPI Number | 1679744734
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Entity Type | Organization
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Legal Business Name | JORGE L. CAMPANA, M.D., P.C.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 6201 LEESBURG PIKE
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2201
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Country | US
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Telephone | 703-534-4277
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Fax | 703-241-5510
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Provider Business Mailing Address
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Address Line | 6201 LEESBURG PIKE SUITE 200
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2201
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Country | US
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Telephone | 703-534-4277
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Fax | 703-241-5510
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Authorized Official
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Title or Position | PRACTICE OWNER/PROVIDER
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Name | MR. JORGE LUIS CAMPANA
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Credential | M.D.
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Telephone | 703-534-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101043415
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License Number State | VA
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