MEDICARE: PETER LAWRENCE CAMPBELL M.D.

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	2084P0800X	Psychiatry Physician	0101029943	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016501T24	OTHER	DC	RR MEDICARE X

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	60484701	OTHER	MD	BCBS MD
3	915610	OTHER	VA	MDIPA/MAMSI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1533	OTHER	VA	CAREFIRST BCBS/GHMSI
6	15330001	OTHER	VA	MAGELLAN
7	175105	OTHER	VA	BCBS VA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	521463549002	OTHER	VA	TRICARE
10	0000000285424	OTHER	VA	ANTHEM BCBS
11	2540172	OTHER	VA	AETNA
12	G3960041	OTHER	DC	BCBS DC

General Provider Information

NPI Number	:	1700897030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER LAWRENCE CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2668
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-0668
Country	:	US
Telephone Number	:	703-492-9961
Fax Number	:	703-497-1225

Provider Business Practice Location Address
First Line	:	12721 DARBY BROOK CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2408
Country	:	US
Telephone Number	:	703-492-9961
Fax Number	:	703-497-1225

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	05/01/2008

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