Provider Demographics
NPI:1467461772
Name:CAMPBELL, DAMALI (MD)
Entity type:Individual
Prefix:
First Name:DAMALI
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:355 GRAND STREET
Mailing Address - Street 2:4 EAST
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2466
Mailing Address - Fax:201-915-2481
Practice Address - Street 1:550 NEWARK AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-795-9155
Practice Address - Fax:201-795-9157
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA66680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
223363012OtherHEALTH CARE PAYERS COAL
223363012OtherGALAXY HEALTH NETWORK INC
7157214OtherAETNA TRADITIONAL
933787OtherGREAT WEST HEALTHCARE
223363012OtherDEVON HEALTH
298582OtherGHI
01006680NJ01OtherANTHEM HEALTH INS CO NY
223363012OtherBEECH STREET CORP
4201372OtherCIGNA
53446OtherAMERIGROUP
0824296000OtherAMERIHEALTH HMO
223363012OtherFAMILY CHOICE
3033693OtherAETNA HMO
915039OtherAMERIHEALTH PPO
01000527400OtherAMERICHOICE
010066680NJ03OtherANTHEM HEALTH INS CO NY
223363012OtherCHN CONSUMER HEALTH NET
NJ8057109Medicaid