Basic Information
| Provider Information | |||||||||
| NPI: | 1952480535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | SHAWN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 S SERVICE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117472354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 WHITEHALL RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038673226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033358159 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
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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 | 207L00000X | 35.088151 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 15210 | NH | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207P00000X | 88151 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3074984 | 05 | NH | MEDICAID |