Provider Demographics
NPI:1801933650
Name:WATKINS CAMPBELL, CATHERINE ELAINE (MD, M P H)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELAINE
Last Name:WATKINS CAMPBELL
Suffix:
Gender:F
Credentials:MD, M P H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 E 22ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3176
Mailing Address - Country:US
Mailing Address - Phone:216-363-2691
Mailing Address - Fax:216-363-3336
Practice Address - Street 1:2322 E 22ND ST STE 101
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:216-363-2691
Practice Address - Fax:216-363-3336
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO2833Medicare UPIN