Provider Demographics
NPI:1992796023
Name:CAMPBELL, TOM EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:EDWARD
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:800-330-6565
Mailing Address - Fax:440-703-2155
Practice Address - Street 1:590 E WESTERN RESERVE RD
Practice Address - Street 2:BUILDING 5
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3354
Practice Address - Country:US
Practice Address - Phone:330-965-9954
Practice Address - Fax:330-965-9958
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-8186207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0533159Medicaid
OH0533159Medicaid