Basic Information
| Provider Information | |||||||||
| NPI: | 1740248004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | KURTIS | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64475 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816566 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2003 MEDICAL PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434813717 | ||||||||
| FaxNumber: | 4434813730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 10/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | D39104 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 2086S0102X | D39104 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086X0206X | D0039104 | MD | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1765510 | 01 | MD | AETNA HMO | OTHER | 0002 | 01 | DC | BCBS | OTHER | 413784100 | 05 | MD | MEDICAID | 4501907 | 01 | MD | AETNA | OTHER | BCBS | 01 | MD | 52828905 | OTHER |