Basic Information
Provider Information | |||||||||
NPI: | 1215045638 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAMPBELL-ARRENDELL | ||||||||
FirstName: | KIMBERLY | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CAMPBELL | ||||||||
OtherFirstName: | KIMBERLY | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 3300 GALLOWS RD | ||||||||
Address2: |   | ||||||||
City: | FALLS CHURCH | ||||||||
State: | VA | ||||||||
PostalCode: | 220423307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037764001 | ||||||||
FaxNumber: | 7037767113 | ||||||||
Practice Location | |||||||||
Address1: | 3300 GALLOWS RD | ||||||||
Address2: |   | ||||||||
City: | FALLS CHURCH | ||||||||
State: | VA | ||||||||
PostalCode: | 220423307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037764001 | ||||||||
FaxNumber: | 7037767113 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/26/2006 | ||||||||
LastUpdateDate: | 12/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0050472 | MD | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 0101233104 | VA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 08202 | 01 | MD | AMERIGROUP | OTHER | 362381501 | 05 | MD |   | MEDICAID | 534928-06 | 01 | MD | BC/BSMD | OTHER | 0001 | 01 | DC | BC/BSDC | OTHER | 0701195 | 01 | MD | UHC COMM | OTHER | 100722 | 01 | MD | PRIORITY PARTNERS | OTHER | 4526432 | 01 | MD | AETNA PPO | OTHER | 502039 | 01 | MD | NCPPO | OTHER | 462201 | 01 | MD | ANTHEM | OTHER | 2995268 | 01 | MD | AETNA HMO | OTHER | 633471 | 01 | MD | MAMSI | OTHER |