Provider Demographics
NPI:1316464613
Name:CAMPO, BERNARD CARL CALLIS (PA)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:CARL CALLIS
Last Name:CAMPO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:CARL
Other - Last Name:CAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 ELLEN CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4282
Mailing Address - Country:US
Mailing Address - Phone:919-902-8025
Mailing Address - Fax:
Practice Address - Street 1:3713 BENSON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7371
Practice Address - Country:US
Practice Address - Phone:919-350-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant