Basic Information
| Provider Information | |||||||||
| NPI: | 1841206711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 856 J CLYDE MORRIS BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944006 | ||||||||
| FaxNumber: | 7575345190 | ||||||||
| Practice Location | |||||||||
| Address1: | 9524 HOSPITAL AVENUE | ||||||||
| Address2: | |||||||||
| City: | NASSAWADOX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574426600 | ||||||||
| FaxNumber: | 7574423839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 09/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101259585 | VA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD21334 | ME | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 160847 | NY | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 01257698 | 05 | NY | MEDICAID | 000434017001 | 01 | NY | BLUE SHIELD NENY/SENIOR B | OTHER | 10000267 | 01 | NY | CDPHP | OTHER | 24114 | 01 | NY | MVP | OTHER | 59F361 | 01 | NY | EMPIRE BCBS | OTHER |