Provider Demographics
NPI:1023263589
Name:CAMPBELL MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:CAMPBELL MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-937-1100
Mailing Address - Street 1:755 CAMPBELL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3715
Mailing Address - Country:US
Mailing Address - Phone:203-937-1100
Mailing Address - Fax:203-937-1102
Practice Address - Street 1:755 CAMPBELL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3715
Practice Address - Country:US
Practice Address - Phone:203-937-1100
Practice Address - Fax:203-937-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002961363LP2300X
CT005583363LF0000X
CT036182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty