Provider Demographics
NPI:1841736832
Name:CAMPBELL, ALISTER
Entity Type:Individual
Prefix:
First Name:ALISTER
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6503
Mailing Address - Country:US
Mailing Address - Phone:757-499-6365
Mailing Address - Fax:757-497-5074
Practice Address - Street 1:5221 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6503
Practice Address - Country:US
Practice Address - Phone:757-499-6365
Practice Address - Fax:757-497-5074
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67272391344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi