Individual
JEFFREY CAMPODONICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
120 SISTER PIERRE DR, SUITE 501, TOWSON, MD 21204-7516
(410) 337-6801
(410) 337-8686
Mailing address
120 SISTER PIERRE DR, SUITE 501, TOWSON, MD 21204-7516
(410) 598-4966
(410) 337-8686
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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