Provider Demographics
NPI:1568688281
Name:CAMPBELL, SUSAN A (L AC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 FAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2322
Mailing Address - Country:US
Mailing Address - Phone:410-465-1669
Mailing Address - Fax:410-465-1669
Practice Address - Street 1:3038 FAWNWOOD DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2322
Practice Address - Country:US
Practice Address - Phone:410-465-1669
Practice Address - Fax:410-465-1669
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01452171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist