Provider Demographics
NPI:1497497564
Name:CAMPBELL, DANIEL JACOB
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JACOB
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4204
Mailing Address - Country:US
Mailing Address - Phone:215-955-6784
Mailing Address - Fax:215-923-4532
Practice Address - Street 1:925 CHESTNUT ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4204
Practice Address - Country:US
Practice Address - Phone:215-955-6760
Practice Address - Fax:215-503-3736
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program