Provider Demographics
NPI:1841493400
Name:CAMPBELL, DIANE JANE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JANE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:JANE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2390 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3775
Practice Address - Country:US
Practice Address - Phone:252-744-4500
Practice Address - Fax:252-744-3472
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12970207V00000X
NC29235207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20965OtherBCBSNC
NC8920965Medicaid
NC8920965Medicaid
NC20965OtherBCBSNC