MEDICARE: MS. MARY MELISSA CAMPBELL L.AC., LMT

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	171100000X	Acupuncturist	117900	NJ

General Provider Information

NPI Number	:	1063860443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY MELISSA CAMPBELL L.AC., LMT

Provider Business Mailing Address
First Line	:	769 ATLANTIC CITY BLVD STE 6
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2540
Country	:	US
Telephone Number	:	732-664-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 ATLANTIC CITY BLVD STE 6
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2540
Country	:	US
Telephone Number	:	732-664-9220
Fax Number	:

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

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	01/23/2023

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