Provider Demographics
NPI:1619930930
Name:CAMPBELL, LYN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:ALLEN
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 1:184C ESTATE DIAMOND RUBY
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4424
Mailing Address - Country:US
Mailing Address - Phone:240-432-3778
Mailing Address - Fax:
Practice Address - Street 1:4000 RUBY PLAZA SUITE 3
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4414
Practice Address - Country:US
Practice Address - Phone:340-277-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1144207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36363Medicare UPIN
VI0059804AMedicare PIN