Provider Demographics
NPI:1831202803
Name:CAMPBELL, MAURA L (MD)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 WINWOOD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1340
Mailing Address - Country:US
Mailing Address - Phone:615-443-6838
Mailing Address - Fax:615-547-9782
Practice Address - Street 1:1411 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-443-6006
Practice Address - Fax:615-443-6086
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL192372085R0001X
KY313912085R0001X
IN01043524A2085R0001X
TN254622085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3045571OtherBCBS GROUP
3715295Medicare ID - Type UnspecifiedMCR GROUP
F46667Medicare UPIN