Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0101255209 | VA |
Y | 111NI0900X | Internist | 0101255209 | VA |
N | 207RA0401X | Internist - Addiction Medicine | 0101255209 | VA |
NPI | 1962451765 |
---|---|
Provider Name | Leopold G Campbell |
First Address | Roanoke, VA 24018-2348 |
Second Address | Roanoke, VA 24018-0605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1383P | BCBS OF NC (01) | NC |
5901417 | (05) | NC |
8533938 | CIGNA (01) | NC |
I20243 | (02) |