Provider Demographics
NPI:1932175049
Name:CAMPUS, TANYA DEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:DEANNE
Last Name:CAMPUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2517
Mailing Address - Country:US
Mailing Address - Phone:978-685-1770
Mailing Address - Fax:978-682-5787
Practice Address - Street 1:150 PARK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2517
Practice Address - Country:US
Practice Address - Phone:978-685-1770
Practice Address - Fax:978-682-5787
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238352207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003968OtherANTHEM
ME0967149005OtherCIGNA
ME290810099Medicaid
ME290810099Medicaid
ME003968OtherANTHEM
ME203840Medicare Oscar/Certification