Provider Demographics
NPI:1194065342
Name:CAMPETTI, EILEEN M (PA-C)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:CAMPETTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:M
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:670 N RIVER STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1027
Mailing Address - Country:US
Mailing Address - Phone:570-208-0150
Mailing Address - Fax:570-208-0154
Practice Address - Street 1:670 N RIVER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1027
Practice Address - Country:US
Practice Address - Phone:570-208-0150
Practice Address - Fax:570-208-0154
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003010363AM0700X
PAMA056029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031985360001Medicaid
PA1031985360001Medicaid