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NPI Code Detail

MEDICARE: DR. MARCIA JO CAMPBELL MD

MEDICARE: DR. MARCIA JO CAMPBELL MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician01036660IN

General Provider Information

NPI Number : 1558346254
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCIA JO CAMPBELL MD
Provider Business Mailing Address
First Line : PO BOX 2267
Second Line : DEPT 5
City : BLOOMINGTON
State : IN
Zip : 47402-2267
Country : US
Telephone Number : 800-756-5986
Fax Number :
Provider Business Practice Location Address
First Line : 601 W 2ND ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2317
Country : US
Telephone Number : 812-336-6821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 11/30/2007

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