Provider Demographics
NPI:1497962914
Name:CAMPBELL, CHARLES T (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 MARINA POINTE DR
Mailing Address - Street 2:UNIT 1606
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-9271
Mailing Address - Country:US
Mailing Address - Phone:310-710-2489
Mailing Address - Fax:
Practice Address - Street 1:2120 COWELL BLVD
Practice Address - Street 2:STE. 142
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7835
Practice Address - Country:US
Practice Address - Phone:818-817-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072321207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology