Provider Demographics
NPI:1063505865
Name:CAMPBELL, WILLIAM WESLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13800 WINTERBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4952
Mailing Address - Country:US
Mailing Address - Phone:301-461-7738
Mailing Address - Fax:
Practice Address - Street 1:13800 WINTERBERRY RDG
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4952
Practice Address - Country:US
Practice Address - Phone:301-461-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033683 ON TINIAN2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB10301Medicare UPIN