Provider Demographics
NPI:1376100834
Name:CAMPBELL, STEWART M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2002 LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3344
Mailing Address - Country:US
Mailing Address - Phone:215-421-0046
Mailing Address - Fax:
Practice Address - Street 1:2002 LUDLOW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3344
Practice Address - Country:US
Practice Address - Phone:215-421-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4828022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry