Provider Demographics
NPI:1538196233
Name:CAMPBELL, ROBERT E (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:STE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4090
Mailing Address - Fax:717-741-3551
Practice Address - Street 1:25 MONUMENT RD STE 290
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5073
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:717-812-4092
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002262363A00000X, 363AS0400X
PAMA055411363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1607986OtherGATEWAY MEDICARE ASSURED
PA2698490OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PAP01283528Medicare PIN
293L / A757Medicare ID - Type Unspecified
PA2698490OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA237249FLTMedicare PIN