Provider Demographics
NPI:1871576389
Name:CAMPAGNOLO, MARY F (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:CAMPAGNOLO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:3242 ROUTE 206
Practice Address - Street 2:BUILDING A SUITE A2
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505
Practice Address - Country:US
Practice Address - Phone:609-298-4340
Practice Address - Fax:609-298-4370
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-06-01
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04269200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1877909Medicaid
NJ515753YBAWMedicare PIN
NJB67218Medicare UPIN