Provider Demographics
NPI:1710389689
Name:CAMPBELL, ALISTER BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISTER
Middle Name:BRUCE
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 1:100 PEARL ST
Mailing Address - Street 2:C.M. SMITH 3RD FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-4506
Mailing Address - Country:US
Mailing Address - Phone:860-990-6349
Mailing Address - Fax:
Practice Address - Street 1:100 PEARL ST
Practice Address - Street 2:C.M. SMITH 3RD FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-4506
Practice Address - Country:US
Practice Address - Phone:860-990-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 37334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine