Provider Demographics
NPI:1316965924
Name:CAMPO, ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CAMPO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 NE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1314
Mailing Address - Country:US
Mailing Address - Phone:561-479-9256
Mailing Address - Fax:561-930-9187
Practice Address - Street 1:1432 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1314
Practice Address - Country:US
Practice Address - Phone:561-479-9256
Practice Address - Fax:561-930-9187
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1704862084P0800X
FLME1134102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE62894Medicare UPIN
NY53M531Medicare ID - Type Unspecified