Provider Demographics
NPI:1053305383
Name:CAMPBELL, DWIN E (DO)
Entity Type:Individual
Prefix:DR
First Name:DWIN
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 IDETOWN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1136
Mailing Address - Country:US
Mailing Address - Phone:570-674-2998
Mailing Address - Fax:570-639-2559
Practice Address - Street 1:221 IDETOWN RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1136
Practice Address - Country:US
Practice Address - Phone:570-674-2998
Practice Address - Fax:570-639-2559
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009630-L208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG88155Medicare UPIN
PA024768Medicare ID - Type Unspecified