Provider Demographics
NPI:1629360979
Name:CAMPBELL, MARC (DO)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ROBINSON ST.
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1755
Mailing Address - Country:US
Mailing Address - Phone:607-724-1391
Mailing Address - Fax:607-773-4387
Practice Address - Street 1:425 ROBINSON ST.
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1755
Practice Address - Country:US
Practice Address - Phone:607-724-1391
Practice Address - Fax:607-773-4387
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63061390200000X
NY2755992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program