Provider Demographics
NPI:1700897030
Name:CAMPBELL, PETER LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:LAWRENCE
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 2668
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-0668
Mailing Address - Country:US
Mailing Address - Phone:703-492-9961
Mailing Address - Fax:703-497-1225
Practice Address - Street 1:12721 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2408
Practice Address - Country:US
Practice Address - Phone:703-492-9961
Practice Address - Fax:703-497-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010299432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016501T24OtherRR MEDICARE X
MD60484701OtherBCBS MD
VA915610OtherMDIPA/MAMSI
VA007103921Medicaid
VA1533OtherCAREFIRST BCBS/GHMSI
VA15330001OtherMAGELLAN
VA175105OtherBCBS VA
VA010145040Medicaid
VA521463549002OtherTRICARE
VA0000000285424OtherANTHEM BCBS
VA2540172OtherAETNA
DCG3960041OtherBCBS DC
VA0000000285424OtherANTHEM BCBS
VA521463549002OtherTRICARE
VAD09623Medicare UPIN
VA010145040Medicaid
VA007103921Medicaid
VAC08443Medicare PIN