Provider Demographics
NPI:1730386715
Name:CAMPBELL, BARRY L (PA-C)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3102
Mailing Address - Country:US
Mailing Address - Phone:207-764-3142
Mailing Address - Fax:
Practice Address - Street 1:180 ACADEMY ST STE 5
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3183
Practice Address - Country:US
Practice Address - Phone:207-764-7200
Practice Address - Fax:207-764-7204
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1730386715Medicaid
ME1730386715Medicaid