Provider Demographics
NPI:1437347820
Name:CAMPOLO, CHRISTINA M (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:CAMPOLO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:MANGOVSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:3085 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:3085 HARLEM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5600
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000529829001OtherBCBS OF WNY
NY9515038OtherIHA
NY00028229501OtherUNIVERA
NY01482255Medicaid
NY080122000011OtherFIDELIS
NY01482255Medicaid