MEDICARE: DR. MICHAEL A CAMPENNI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	AZ4639	AZ
2	208800000X	Urology Physician	OS008694L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48716	OTHER	PA	GEISINGER HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053313478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A CAMPENNI D.O.

Provider Business Mailing Address
First Line	:	250 KENNEDY BLVD UNIT 2
Second Line	:
City	:	PITTSTON
State	:	PA
Zip	:	18640-1811
Country	:	US
Telephone Number	:	570-491-8141
Fax Number	:	570-891-4284

Provider Business Practice Location Address
First Line	:	250 KENNEDY BLVD UNIT 2
Second Line	:
City	:	PITTSTON
State	:	PA
Zip	:	18640-1811
Country	:	US
Telephone Number	:	570-491-8141
Fax Number	:	570-891-4284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/29/2022

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Directions to “ DR. MICHAEL A CAMPENNI D.O.” Practice Location

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