Provider Demographics
NPI:1215967708
Name:CAMPBELL, RONALD R (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TWO GREAT FALLS PLAZA
Mailing Address - Street 2:#22
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-782-7640
Mailing Address - Fax:207-784-4868
Practice Address - Street 1:TWO GREAT FALLS PLAZA
Practice Address - Street 2:#22
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-782-7640
Practice Address - Fax:207-784-4868
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME88992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003534OtherBCBS STAR #
ME23003000Medicaid
ME021733Medicare ID - Type Unspecified
ME23003000Medicaid