Individual
JEFFREY CAMPODONICO
Active
Individual
JEFFREY CAMPODONICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
3071
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403513500
—
MD
01
—
706M
MEDICARE GROUP ID NO.
MD
01
—
KEJ2JE
BCBS PREFERRED PROVIDER
MD
Enumeration date
01/18/2007
Last updated
01/24/2009
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