Provider Demographics
NPI:1194935718
Name:CAMPAGNA, RALPH T (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:T
Last Name:CAMPAGNA
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 PUTNAM ROAD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239
Mailing Address - Country:US
Mailing Address - Phone:860-779-6500
Mailing Address - Fax:860-779-6501
Practice Address - Street 1:594 PUTNAM ROAD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239
Practice Address - Country:US
Practice Address - Phone:860-779-6500
Practice Address - Fax:860-779-6501
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT138237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist