Provider Demographics
NPI:1922033521
Name:CAMPO, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CAMPO
Suffix:
Gender:M
Credentials:MD
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 REYNOLDS ST
Practice Address - Street 2:STE 100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4375
Practice Address - Country:US
Practice Address - Phone:704-289-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922033521Medicaid
SCN0122CMedicaid
NC140JGOtherBCBS
NC5901620Medicaid
NC5901620Medicaid
SCN0122CMedicaid
NCD01216Medicare UPIN
NC2045038Medicare PIN
NCNC8581AMedicare PIN