MEDICARE: JORGE LUIS CAMPANA 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	207W00000X	Ophthalmology Physician	0101043415	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811981483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS CAMPANA M.D.

Provider Business Mailing Address
First Line	:	6201 LEESBURG PIKE
Second Line	:	SUITE 200
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2201
Country	:	US
Telephone Number	:	703-534-4277
Fax Number	:	703-241-5510

Provider Business Practice Location Address
First Line	:	6201 LEESBURG PIKE
Second Line	:	SUITE 200
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2201
Country	:	US
Telephone Number	:	703-534-4277
Fax Number	:	703-241-5510

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	04/14/2010

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