Provider Demographics
NPI:1679813679
Name:CAMPBELL, REBECCA P (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:P
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-3137
Practice Address - Fax:410-502-3944
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2018-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC06645363A00000X
DEJ3-00004582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer