Provider Demographics
NPI:1326217415
Name:CAMPBELL, JOHN REXFORD (ATP, RET)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REXFORD
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:ATP, RET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-9642
Mailing Address - Country:US
Mailing Address - Phone:570-300-1808
Mailing Address - Fax:570-300-1808
Practice Address - Street 1:315 HOWELL RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-9642
Practice Address - Country:US
Practice Address - Phone:570-338-0128
Practice Address - Fax:570-300-1808
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZB0301X
VAATP,RET246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246ZB0301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiomedical Engineering
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102086535Medicaid