Provider Demographics
NPI:1225052285
Name:CAMPBELL, ANDREW BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRUCE
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 1:27005 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2383
Mailing Address - Country:US
Mailing Address - Phone:888-365-5514
Mailing Address - Fax:800-616-0084
Practice Address - Street 1:1610 NE 1ST ST APT 10
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3800
Practice Address - Country:US
Practice Address - Phone:954-760-4306
Practice Address - Fax:954-760-4306
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME973392085P0229X, 2085R0202X
NY153691-012085R0202X
NJ25MA081781002085R0202X
PAMD044591L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002112500Medicaid
NJ8516804Medicaid
OK200251600AMedicaid
MS00476269Medicaid
MI1225052285Medicaid
LA2198547Medicaid
TN4047842Medicaid
SD1225052285Medicaid
KY7100084150Medicaid
NM99073889Medicaid
OH307496Medicaid
PA0018425910010Medicaid
TX205764802Medicaid