Provider Demographics
NPI:1326088816
Name:CAMPBELL, PATRICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13955
Mailing Address - Street 2:LIBERTY DOCTORS, LLC PATRICIA A CAMPBELL MD
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-225-8304
Mailing Address - Fax:843-225-3549
Practice Address - Street 1:110A SPRINGHALL DR
Practice Address - Street 2:LIBERTY DOCTORS, LLC PATRICIA A CAMPBELL MD
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-266-2520
Practice Address - Fax:843-553-4436
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC16192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC161924Medicaid
SCGP4999Medicaid
SCP00689239OtherMEDICARE RR
SCF587617126Medicare PIN
SCF58961Medicare UPIN
SC161924Medicaid