Provider Demographics
NPI:1912983735
Name:CAMPBELL, VIDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDA
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIDA
Other - Middle Name:S
Other - Last Name:ASHRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:415-883-8082
Practice Address - Street 1:795 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-853-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG790492085N0700X, 2085R0202X
WAMD000324812085N0700X
WAMD00032412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8279051Medicaid
WA300123267OtherRAILROAD MEDICARE
CA00G790490Medicaid
CA300121747OtherRAILROAD MEDICARE
WA300123267OtherRAILROAD MEDICARE
CAG77790Medicare UPIN
CA00G790490Medicaid
CA300121747OtherRAILROAD MEDICARE
CABW276Medicare PIN
WA8279051Medicaid
CABW280Medicare PIN
CABW274Medicare PIN