Provider Demographics
NPI:1528041613
Name:CAMPBELL, DWIGHT D (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:D
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:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2337
Mailing Address - Country:US
Mailing Address - Phone:315-422-2933
Mailing Address - Fax:315-422-3909
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5163
Practice Address - Fax:315-376-0372
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213337207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01915186Medicaid
NY01915186Medicaid
NYJ400004058Medicare PIN
NYC66382Medicare UPIN
NYP00725994Medicare PIN