Provider Demographics
NPI:1972670099
Name:ANTHONY G CAMPO JR MD PA
Entity Type:Organization
Organization Name:ANTHONY G CAMPO JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-653-8040
Mailing Address - Street 1:223 SHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-653-8040
Mailing Address - Fax:609-653-1568
Practice Address - Street 1:223 SHORE ROAD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-653-8040
Practice Address - Fax:609-653-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA31043OtherDR CAMPO STATE LICENSE NU
0103516000OtherAMERIHEALTH
O19697Medicare UPIN
NJMA31043OtherDR CAMPO STATE LICENSE NU