Provider Demographics
NPI:1447253554
Name:CAMPANELLA, PETER CARL (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CARL
Last Name:CAMPANELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1174
Mailing Address - Country:US
Mailing Address - Phone:610-678-4552
Mailing Address - Fax:610-678-7007
Practice Address - Street 1:3855 PENN AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1174
Practice Address - Country:US
Practice Address - Phone:610-678-4552
Practice Address - Fax:610-678-7007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057801L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA869197Medicare ID - Type Unspecified
PAG27374Medicare UPIN