Provider Demographics
NPI:1447326293
Name:CAMPANELLI, CARMEN DAVID JR (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:DAVID
Last Name:CAMPANELLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9334
Mailing Address - Country:US
Mailing Address - Phone:302-777-2425
Mailing Address - Fax:
Practice Address - Street 1:903 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5515
Practice Address - Country:US
Practice Address - Phone:215-579-6155
Practice Address - Fax:215-860-0723
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10006811207NP0225X, 207NS0135X, 207N00000X, 207ND0101X, 207ND0900X
PAMD430789207NS0135X, 207ND0101X, 207N00000X, 207ND0900X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEI43011Medicare UPIN