Provider Demographics
NPI:1710963327
Name:CAMPBELL, CONNIE J (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 WASHINGTON PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6750
Mailing Address - Country:US
Mailing Address - Phone:603-656-0326
Mailing Address - Fax:603-656-0329
Practice Address - Street 1:9 WASHINGTON PL
Practice Address - Street 2:SUITE 203
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6750
Practice Address - Country:US
Practice Address - Phone:603-656-0326
Practice Address - Fax:603-656-0329
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH10856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5268706OtherAETNA HMO
NH2366OtherCIGNA
NH01YOO2356NH01OtherANTHEM
NH30200662Medicaid
NH010856OtherTUFTS HEALTH PLAN
NH2315992OtherAETNA
NHNH1846OtherHARVARD PILGRIM HEALTHCAR
NH010856OtherTUFTS HEALTH PLAN
NHNH1846OtherHARVARD PILGRIM HEALTHCAR