Provider Demographics
NPI:1841379658
Name:VANESSA A CAMPERLENGO MD PC
Entity Type:Organization
Organization Name:VANESSA A CAMPERLENGO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:CAMPERLENGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-975-4440
Mailing Address - Street 1:675 PETER JEFFERSON PARKWAY
Mailing Address - Street 2:SUITE 335
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8618
Mailing Address - Country:US
Mailing Address - Phone:434-975-4440
Mailing Address - Fax:434-975-5551
Practice Address - Street 1:675 PETER JEFFERSON PARKWAY
Practice Address - Street 2:SUITE 335
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8618
Practice Address - Country:US
Practice Address - Phone:434-975-4440
Practice Address - Fax:434-975-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01010445622084P0800X
320800000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
051840OtherANTHEM BLUE CROSS BLUE SH
VA007103794Medicaid
VA007103794Medicaid
F20432Medicare UPIN