Provider Demographics
NPI:1265541056
Name:CAMPO, ALFONSE MARIANO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSE
Middle Name:MARIANO
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 1:121 WARDE TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3632
Mailing Address - Country:US
Mailing Address - Phone:203-979-0991
Mailing Address - Fax:203-846-0047
Practice Address - Street 1:121 WARDE TER
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3632
Practice Address - Country:US
Practice Address - Phone:203-979-0991
Practice Address - Fax:203-846-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine