Provider Demographics
NPI:1932109089
Name:CAMPBELL, JOSEPH DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVIS
Last Name:CAMPBELL
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 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 405
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-876-8225
Mailing Address - Fax:919-876-3371
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:SUITE 405
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-876-8225
Practice Address - Fax:919-876-3371
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35289207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920877Medicaid
F34877Medicare UPIN
NC8920877Medicaid