Active NPI
Carla Campbell, MD
- Pediatrics Physician
- Philadelphia, PA
National Provider Identifier
1255352795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD-045435-L
- Practice address
- 39TH and Chestnut St
St. Leonard'S Court, Suite 110
Philadelphia, PA 19104 - Phone
- (215) 590-5090
- Fax
- (215) 590-5048
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD-045435-L | PA | Primary |
Addresses
Primary practice location
39TH and Chestnut St
St. Leonard'S Court, Suite 110
Philadelphia, PA 19104
Mailing address
39TH and Chestnut St
St. Leonard'S Court, Suite 110
Philadelphia, PA 19104
Phone (215) 590-5090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1278902 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-045435-L | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255352795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39TH AND CHESTNUT ST",
"address_2": "ST. LEONARD'S COURT, SUITE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-5090",
"fax_number": "215-590-5048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39TH AND CHESTNUT ST",
"address_2": "ST. LEONARD'S COURT, SUITE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-5090",
"fax_number": "215-590-5048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "CARLA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD-045435-L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1278902",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.