Provider Demographics
NPI:1740277458
Name:CAMPBELL, CYNTHIA HEATHER (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:HEATHER
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:CAMPBELL
Other - Last Name:HAITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4357 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2603
Mailing Address - Country:US
Mailing Address - Phone:301-352-6515
Mailing Address - Fax:301-352-6516
Practice Address - Street 1:4357 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2603
Practice Address - Country:US
Practice Address - Phone:301-352-6515
Practice Address - Fax:301-352-6516
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI19259Medicare UPIN