Provider Demographics
NPI:1053313478
Name:CAMPENNI, MICHAEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:CAMPENNI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KENNEDY BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1811
Mailing Address - Country:US
Mailing Address - Phone:570-491-8141
Mailing Address - Fax:570-891-4284
Practice Address - Street 1:250 KENNEDY BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1811
Practice Address - Country:US
Practice Address - Phone:570-491-8141
Practice Address - Fax:570-891-4284
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4639208800000X
PAOS008694L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA48716OtherGEISINGER HEALTH PLAN
PA0017424060001Medicaid
AZ328233Medicaid
G89432Medicare UPIN
AZ328233Medicaid
AZZ121959Medicare PIN
PA1742406Medicaid