Individual
DR. NEDSON JOHN CAMPBELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-3434
(860) 647-6829
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-3434
(860) 647-6829
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
050231
CT
2084P0802X
Addiction Psychiatry Physician
050231
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004025177
—
CT
05
—
004041000
—
CT
05
—
004082260
—
CT
05
—
004082286
—
CT
05
—
004217099
—
CT
05
—
008001325
—
CT
05
—
008003745
—
CT
05
—
008022622
—
CT
05
—
008022626
—
CT
05
—
008023170
—
CT
05
—
008024427
—
CT
05
—
008039745
—
CT
05
—
008042339
—
CT
05
—
008045321
—
CT
05
—
500000315
—
CT
01
—
C01033
APT PTAN MEDICARE
CT
01
—
D400092056
PTAN GROUP MEMBER NUMBER
CT
Enumeration date
05/05/2009
Last updated
02/09/2015
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