Provider Demographics
NPI:1902136476
Name:CAMPBELL, DAVID IAN
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IAN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3301
Mailing Address - Country:US
Mailing Address - Phone:203-843-4775
Mailing Address - Fax:
Practice Address - Street 1:22 APPLE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3301
Practice Address - Country:US
Practice Address - Phone:203-843-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013115207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology