Provider Demographics
NPI:1245231000
Name:CAMPBELL, KEVIN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARTIN
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:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-0775
Mailing Address - Country:US
Mailing Address - Phone:610-237-4561
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE STE 3006
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1306
Practice Address - Country:US
Practice Address - Phone:610-237-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031598E207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001046695Medicaid
PA001046695Medicaid
PAC30684Medicare UPIN
P00142062Medicare PIN