Provider Demographics
NPI:1730117268
Name:CAMPBELL, TERENCE D (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2916 VANGADER DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1744
Mailing Address - Country:US
Mailing Address - Phone:740-453-9616
Mailing Address - Fax:740-453-4940
Practice Address - Street 1:2916 VANGADER DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1744
Practice Address - Country:US
Practice Address - Phone:740-453-9616
Practice Address - Fax:740-453-4940
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057774208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0727191Medicaid
AC3195422OtherDEA
AC3195422OtherDEA
OH0727191Medicaid