Provider Demographics
NPI:1528022902
Name:CAMPBELL, TIMOTHY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
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 1:1370 WASHINGTON PIKE
Mailing Address - Street 2:STE 401
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2873
Mailing Address - Country:US
Mailing Address - Phone:142-279-7800
Mailing Address - Fax:412-279-1774
Practice Address - Street 1:1370 WASHINGTON PIKE
Practice Address - Street 2:STE 401
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2873
Practice Address - Country:US
Practice Address - Phone:142-279-7800
Practice Address - Fax:412-279-1774
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABC1100243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016192890001Medicaid
PA0016192890001Medicaid
PA153885Medicare ID - Type Unspecified