Provider Demographics
NPI:1073516191
Name:CAMPBELL, LAWRENCE D (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:CAMPBELL
Suffix:
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 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8301
Mailing Address - Country:US
Mailing Address - Phone:631-969-9600
Mailing Address - Fax:631-968-7624
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8301
Practice Address - Country:US
Practice Address - Phone:631-969-9600
Practice Address - Fax:631-968-7624
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166249-1207R00000X
VT042.0013988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C4541OtherPHS / HEALTHNET
NYAA4619SOtherMDNY
NYCP498OtherOXFORD
NY000AN2OtherEMPIRE BCBS
NY00977793Medicaid
NY166249POtherHEALTHCARE PARTNERS HIP
NY0000044342306OtherUNITED HEALTHCARE
NY35856OtherVYTRA
NY6077DOtherMAGNACARE
NY131673OtherONE HEALTH
NY433152NOtherCIGNA
NYA400023513Medicare PIN
NYAA4619SOtherMDNY
NY00977793Medicaid