Provider Demographics
NPI:1114259389
Name:CAMPBELL, CHARLES LADOUE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LADOUE
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 1:1457 WOODSIDE CT S
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2723
Mailing Address - Country:US
Mailing Address - Phone:757-621-3520
Mailing Address - Fax:
Practice Address - Street 1:1457 WOODSIDE CT S
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2723
Practice Address - Country:US
Practice Address - Phone:757-621-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239178208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice