Provider Demographics
NPI:1669435475
Name:CAMPBELL, MARC W (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:W
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:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:1415 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1413
Practice Address - Country:US
Practice Address - Phone:812-630-9794
Practice Address - Fax:812-996-0653
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036961A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000537927OtherANTHEM PIN
IN100338320Medicaid
IN250470OtherMEDICARE GROUP
IN200859330COtherMEDICAID GROUP
IN200859330COtherMEDICAID GROUP
IN250470OtherMEDICARE GROUP