Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS003748L | PA |
NPI | 1679521041 |
---|---|
Provider Name | Thomas M Campbell |
First Address | Kingston, PA 18704-3715 |
Second Address | Kingston, PA 18704-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |