Individual
DR. PENELOPE ANNE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4022 POSTAL WAY STE C, MYRTLE BEACH, SC 29579-3537
(843) 903-4111
(843) 903-4242
Mailing address
PO BOX 50760, MYRTLE BEACH, SC 29579-0013
(843) 903-4111
(843) 903-4242
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
27349
SC
2080A0000X
Pediatric Adolescent Medicine Physician
27349
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570783896
FED TAX ID
SC
01
—
7844
MEDICARE PTAN
SC
05
—
GP4505
—
SC
Enumeration date
04/21/2006
Last updated
02/02/2012
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