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NPI Code Detail

MEDICARE: DR. SUSAN KELLER CAMPBELL M.D.

MEDICARE: DR. SUSAN KELLER 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
1207Q00000XFamily Medicine Physician0101050838VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12154106OTHERUNITED HEALTHCARE MAMSI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3334844OTHERANTHEM HEALTHKEEPERS PLUS
4804791OTHERAETNA
550320001OTHERCAREFIRST
6259951OTHERUNITED HEALTHCARE MAMSI
78154106OTHERUNITED HEALTHCARE MAMSI

General Provider Information

NPI Number : 1760545479
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN KELLER CAMPBELL M.D.
Provider Business Mailing Address
First Line : 8650 SUDLEY RD
Second Line : SUITE 306
City : MANASSAS
State : VA
Zip : 20110-4419
Country : US
Telephone Number : 703-393-9494
Fax Number : 703-393-8591
Provider Business Practice Location Address
First Line : 8650 SUDLEY RD
Second Line : SUITE 306
City : MANASSAS
State : VA
Zip : 20110-4419
Country : US
Telephone Number : 703-393-9494
Fax Number : 703-393-8591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/09/2007

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Directions to “ DR. SUSAN KELLER CAMPBELL M.D.” Practice Location

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