Basic Information
| Provider Information | |||||||||
| NPI: | 1992873053 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KAREN CAMPBELL, DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 GLENN AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178151200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703872022 | ||||||||
| FaxNumber: | 5703872203 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 GLENN AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178151200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703872022 | ||||||||
| FaxNumber: | 5703872203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PODIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 5703872022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | SC003080-L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.