Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | AZ4639 | AZ |
Y | 208800000X | Urologist | OS008694L | PA |
NPI | 1053313478 |
---|---|
Provider Name | Dr. Michael A Campenni |
First Address | Plains, PA 18705-1032 |
Second Address | Plains, PA 18705-1032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 05/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017424060001 | (05) | PA |
328233 | (05) | AZ |
48716 | GEISINGER HEALTH PLAN (01) | PA |
G89432 | (02) |