Provider Demographics
NPI:1437564150
Name:CAMPBELL, JOSHUA CLARK (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CLARK
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:3580 JOSEPH SIEWICK DR STE 105
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1764
Practice Address - Country:US
Practice Address - Phone:703-970-6464
Practice Address - Fax:703-970-6565
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD047881207XS0114X
VA0101275083207X00000X
MDD83628207X00000X
CAA130780207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD83628OtherMARYLAND MEDICAL LICENSE
CAA130780OtherCALIFORNIA MEDICAL LICENSE
DCMD047881OtherDC MEDICAL LICENSE