Provider Demographics
NPI:1902871262
Name:CAMPBELL, DIANE SHARON (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SHARON
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 PLEASANT LAKE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2552
Mailing Address - Country:US
Mailing Address - Phone:508-432-5233
Mailing Address - Fax:508-430-0511
Practice Address - Street 1:253 PLEASANT LAKE AVE
Practice Address - Street 2:STE 100
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2552
Practice Address - Country:US
Practice Address - Phone:508-432-5233
Practice Address - Fax:508-430-0511
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME080073871OtherRAILROAD MEDICARE PIN
MA110092283AMedicaid
ME080073871Medicare PIN
MEMM1085Medicare ID - Type Unspecified
ME268670099Medicaid
MEMM108501Medicare PIN