Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | C10006811 | DE |
N | 207N00000X | Dermatologist | MD430789 | PA |
N | 207ND0101X | MOHS-Micrographic Surgeon | C10006811 | DE |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD430789 | PA |
N | 207ND0900X | Dermatopathologist | C10006811 | DE |
N | 207ND0900X | Dermatopathologist | MD430789 | PA |
N | 207NP0225X | Pediatric Dermatologist | C10006811 | DE |
N | 207NP0225X | Pediatric Dermatologist | MD430789 | PA |
N | 207NS0135X | Procedural Dermatology | C10006811 | DE |
N | 207NS0135X | Procedural Dermatology | MD430789 | PA |
NPI | 1447326293 |
---|---|
Provider Name | Dr. Carmen David Campanelli JR. |
First Address | Chadds Ford, PA 19317-9334 |
Second Address | Yardley, PA 19067-5515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I43011 | (02) | DE |