Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 34013240 | OH |
NPI | 1306230255 |
---|---|
Provider Name | Alexander Campolo |
First Address | Newark, OH 43055-2303 |
Second Address | Newark, OH 43055-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0241035 | (05) | OH |