Provider Demographics
NPI:1710270889
Name:CAMPBELL, EWA ANNA (MD)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:ANNA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4097
Mailing Address - Country:US
Mailing Address - Phone:937-435-9013
Mailing Address - Fax:937-435-1458
Practice Address - Street 1:979 CONGRESS PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4009
Practice Address - Country:US
Practice Address - Phone:937-435-9013
Practice Address - Fax:937-435-1458
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123836207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107359Medicaid
OH0107359Medicaid
OHH351622Medicare PIN