Provider Demographics
NPI:1366442360
Name:CAMPBELL, DOUGLAS E (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 NEW UTRECHT AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2554
Mailing Address - Country:US
Mailing Address - Phone:718-853-7469
Mailing Address - Fax:718-972-7679
Practice Address - Street 1:4626 NEW UTRECHT AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2554
Practice Address - Country:US
Practice Address - Phone:718-853-7469
Practice Address - Fax:718-972-7679
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5147213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU61586Medicare UPIN
NYP27472Medicare PIN