Provider Demographics
NPI:1841393816
Name:CAMPOLI, LARRY (DPM)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:CAMPOLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2413
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-1413
Mailing Address - Country:US
Mailing Address - Phone:724-935-9030
Mailing Address - Fax:724-776-4065
Practice Address - Street 1:5830 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9668
Practice Address - Country:US
Practice Address - Phone:724-443-7231
Practice Address - Fax:734-443-4467
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002928-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010721760004Medicaid
PA183240OtherBLUE CROSS BLUE SHIELD
PA13943OtherELDERHEALTH
PA88375Medicaid
PA1362204OtherUNITED MINE WORKERS AMER
PA183240Other65 SPECIAL MEDIGAP BC BS
PA1504983Medicaid
PAT29990Medicare UPIN
PA183240Medicare ID - Type UnspecifiedMEDICARE ID NUMBER