Provider Demographics
NPI:1043299175
Name:CAMPBELL, WILLIAM EGBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EGBERT
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MOREHEAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E MOREHEAD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2742
Practice Address - Country:US
Practice Address - Phone:704-334-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC319652085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920986Medicaid
SC18881OtherSC MEDICAL LICENSE
NC20986OtherNC BLUE CROSS BLUE SHIELD
NC31965OtherN MEDICAL LICENSE
PAMD030659OtherPA MEDICAL LICENSE
SCN31965Medicaid
SCN31965Medicaid
PAMD030659OtherPA MEDICAL LICENSE
NC8920986Medicaid
300108332Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE