Provider Demographics
NPI:1306841952
Name:CAMPBELL, MARK CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:615 HOWARD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4813
Mailing Address - Country:US
Mailing Address - Phone:814-949-2950
Mailing Address - Fax:814-949-2960
Practice Address - Street 1:615 HOWARD AVE
Practice Address - Street 2:STE 106
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4813
Practice Address - Country:US
Practice Address - Phone:814-949-2950
Practice Address - Fax:814-949-2960
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419670207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73685OtherGEISINGER HEALTH PLAN
PA2205695OtherUNITED HEALTHCARE
PA7288373OtherAETNA PROVIDER PIN#
PA0019123370005Medicaid
PA1526324OtherGATEWAY HEALTH PLAN
PA000000160767OtherUNISON PROVIDER PIN #
PA310596OtherUPMC HEALTH PLAN
PA063127 S9YMedicare PIN
PA000000160767OtherUNISON PROVIDER PIN #
PA1526324OtherGATEWAY HEALTH PLAN