Provider Demographics
NPI:1215978614
Name:ADULT AND ADOLESCENT MEDICINE OF MIDDLETOWN,LLC
Entity type:Organization
Organization Name:ADULT AND ADOLESCENT MEDICINE OF MIDDLETOWN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-376-8899
Mailing Address - Street 1:102 SLEEPY HOLLOW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8894
Mailing Address - Country:US
Mailing Address - Phone:302-376-8899
Mailing Address - Fax:302-376-8890
Practice Address - Street 1:102 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8894
Practice Address - Country:US
Practice Address - Phone:302-376-8899
Practice Address - Fax:302-376-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004487207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02201Medicare ID - Type UnspecifiedGROUP IDENTIFIER