Provider Demographics
NPI:1366626509
Name:CAMPOS, MARITE (MD)
Entity Type:Individual
Prefix:
First Name:MARITE
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2297
Mailing Address - Country:US
Mailing Address - Phone:717-316-2150
Mailing Address - Fax:717-637-4575
Practice Address - Street 1:300 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2297
Practice Address - Country:US
Practice Address - Phone:717-316-2150
Practice Address - Fax:717-637-4575
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243873207ZP0102X
NJ25MA08620500207ZP0102X
CAA100688207ZP0102X
GA78877207ZP0102X
PAMD459190207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology