Provider Demographics
NPI:1316059199
Name:CAMPBELL, JOHN STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2510
Mailing Address - Country:US
Mailing Address - Phone:540-932-2222
Mailing Address - Fax:540-886-7364
Practice Address - Street 1:184 HICKORY HILL RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2510
Practice Address - Country:US
Practice Address - Phone:540-932-2222
Practice Address - Fax:540-886-7364
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA431536OtherANTHEM
VA27181800002OtherSOUTHERN HEALTH
VA7601689Medicaid
VA27181800002OtherSOUTHERN HEALTH
VA7601689Medicaid