Provider Demographics
NPI:1174304810
Name:CAMPBELL, CAWAYNE MARIO (PA)
Entity type:Individual
Prefix:MR
First Name:CAWAYNE
Middle Name:MARIO
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1328 HICKS ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1739
Mailing Address - Country:US
Mailing Address - Phone:347-904-5842
Mailing Address - Fax:
Practice Address - Street 1:1328 HICKS ST APT 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1739
Practice Address - Country:US
Practice Address - Phone:347-904-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant