Provider Demographics
NPI:1306878749
Name:CONNIE J CAMPBELL, MD, PLLC
Entity type:Organization
Organization Name:CONNIE J CAMPBELL, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-656-0326
Mailing Address - Street 1:765 S MAIN ST
Mailing Address - Street 2:#101
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5141
Mailing Address - Country:US
Mailing Address - Phone:603-656-0326
Mailing Address - Fax:603-656-0329
Practice Address - Street 1:765 S MAIN ST
Practice Address - Street 2:#101
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5141
Practice Address - Country:US
Practice Address - Phone:603-656-0326
Practice Address - Fax:603-656-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212367Medicaid
NH30212367Medicaid
=========OtherTAX ID