Provider Demographics
NPI:1962451765
Name:CAMPBELL, LEOPOLD G (MD)
Entity Type:Individual
Prefix:
First Name:LEOPOLD
Middle Name:G
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 1:4730 SUSSEX CT APT G
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2348
Mailing Address - Country:US
Mailing Address - Phone:704-591-2819
Mailing Address - Fax:
Practice Address - Street 1:4346 STARKEY RD STE 1
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0605
Practice Address - Country:US
Practice Address - Phone:540-772-8043
Practice Address - Fax:540-772-8242
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255209207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1383POtherBCBS OF NC
NC8533938OtherCIGNA
NC5901417Medicaid
NC1383POtherBCBS OF NC
NC8533938OtherCIGNA