Provider Demographics
NPI:1356419931
Name:CAMPBELL & VERDUCCI
Entity type:Organization
Organization Name:CAMPBELL & VERDUCCI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-938-5916
Mailing Address - Street 1:670 THIRD ST WEST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476
Mailing Address - Country:US
Mailing Address - Phone:707-938-5916
Mailing Address - Fax:707-938-8496
Practice Address - Street 1:670 THIRD ST WEST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476
Practice Address - Country:US
Practice Address - Phone:707-938-5916
Practice Address - Fax:707-938-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083820Medicaid
CAZZZ15202ZMedicare PIN