Provider Demographics
NPI:1104894815
Name:CAMPBELL, KEVIN C (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 PICCARD DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4303
Mailing Address - Country:US
Mailing Address - Phone:301-921-7900
Mailing Address - Fax:301-921-7915
Practice Address - Street 1:1701 NORTH GEORGE MASON DRIVE
Practice Address - Street 2:VIRGINIA HOSPITAL CENTER
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-558-6167
Practice Address - Fax:703-558-5355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101052195207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007178E14Medicare ID - Type Unspecified
H35541Medicare UPIN