Provider Demographics
NPI:1013760412
Name:CAMPBELL, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 10TH ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-6607
Mailing Address - Country:US
Mailing Address - Phone:302-572-9622
Mailing Address - Fax:
Practice Address - Street 1:100 W 10TH ST STE 1100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-6607
Practice Address - Country:US
Practice Address - Phone:302-572-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
DE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes174H00000XOther Service ProvidersHealth Educator