MEDICARE: DR. COLIN A CAMPBELL 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	207R00000X	Internal Medicine Physician	MB67354	NJ
2	207R00000X	Internal Medicine Physician	25MB06735400	NJ

General Provider Information

NPI Number	:	1477518132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN A CAMPBELL D.O.

Provider Business Mailing Address
First Line	:	P.O. BOX 1683
Second Line	:
City	:	BLACKWOOD
State	:	NJ
Zip	:	08012
Country	:	US
Telephone Number	:	856-767-2000
Fax Number	:	856-767-0073

Provider Business Practice Location Address
First Line	:	299 S ROUTE 73 STE A
Second Line	:
City	:	WEST BERLIN
State	:	NJ
Zip	:	08091-3702
Country	:	US
Telephone Number	:	856-767-2000
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	12/10/2020

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