Provider Demographics
NPI:1851341762
Name:CAMPO, FRANK SALVATORE (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:SALVATORE
Last Name:CAMPO
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 1:260 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-2106
Mailing Address - Country:US
Mailing Address - Phone:617-248-8682
Mailing Address - Fax:617-248-0319
Practice Address - Street 1:260 NORTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-2106
Practice Address - Country:US
Practice Address - Phone:617-248-8682
Practice Address - Fax:617-248-0319
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1907213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0362034Medicaid
MACAY70896Medicare ID - Type UnspecifiedMEDICARE
MA0362034Medicaid