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General NPI Number Information
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NPI Number | 1790956118
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Entity Type | Organization
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Legal Business Name | JEFFREY R. CAMPODONICO, PH.D., P.A.
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 120 SISTER PIERRE DR SUITE 501
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City | TOWSON
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State | MD
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Zip | 21204-7516
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Country | US
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Telephone | 410-337-6801
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Fax | 410-337-8686
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Provider Business Mailing Address
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Address Line | 529 PICCADILLY RD
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City | TOWSON
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State | MD
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Zip | 21204-3716
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Country | US
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Telephone | 410-598-4966
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Fax | 410-337-8686
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. JEFFREY RUDOLPH CAMPODONICO
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Credential | PH.D.
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Telephone | 410-337-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3071
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License Number State | MD
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