Provider Demographics
NPI:1518034636
Name:CAMPO, ANTHONY GUY JR (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GUY
Last Name:CAMPO
Suffix:JR
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 1:223 SHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-653-8040
Mailing Address - Fax:609-653-1568
Practice Address - Street 1:223 SHORE ROAD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-653-8040
Practice Address - Fax:609-653-1568
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA31043207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA31043OtherSTATE LICENSE NUMBER
0103516000OtherAMERI HEALTH
451056Medicare ID - Type Unspecified
NJMA31043OtherSTATE LICENSE NUMBER