Provider Demographics
NPI:1073741393
Name:CAMPBELL, TONY LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211
Mailing Address - Country:US
Mailing Address - Phone:614-268-8221
Mailing Address - Fax:614-263-1891
Practice Address - Street 1:2339 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1609
Practice Address - Country:US
Practice Address - Phone:614-268-8221
Practice Address - Fax:614-263-1891
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant