Provider Demographics
NPI:1083005771
Name:CAMPBELL, AMANDA M (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CLARENDON BLVD APT E312
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5085
Mailing Address - Country:US
Mailing Address - Phone:703-489-9711
Mailing Address - Fax:
Practice Address - Street 1:3803 FAIRFAX DR STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-5860
Practice Address - Country:US
Practice Address - Phone:703-881-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101278006207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology