Provider Demographics
NPI:1922078484
Name:CAMPBELL, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
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 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:833-232-3632
Practice Address - Street 1:540 BELVEDERE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-654-2830
Practice Address - Fax:833-232-3632
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA267051OtherMAMSI
VA45184Medicaid
VA700010938OtherCIGNA
VA080141644OtherMEDICARE PIN
VA45184OtherCOMMUNITY HEALTH
VA142735OtherSOUTHERN HEALTH
VA005638615Medicaid
VA234065OtherANTHEM SVCS/HEALTHKEEPERS
VA080007006Medicare PIN
VA080141644OtherMEDICARE PIN
VA005638615Medicaid