Provider Demographics
NPI:1497755425
Name:CAMPBELL, PHYLLIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:E
Last Name:CAMPBELL
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 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-997-0580
Mailing Address - Fax:410-740-8587
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-997-0580
Practice Address - Fax:410-740-8587
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33911207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5270014Medicaid
MD5270014Medicaid
354P715GMedicare PIN