Individual
DR. ERNEST JOHN CAMPONOVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3700 PARK EAST DRIVE, SUITE 450, BEACHWOOD, OH 44122-4305
(855) 292-1401
(866) 393-8340
Mailing address
3700 PARK EAST DRIVE, SUITE 450, BEACHWOOD, OH 44122-4305
(855) 292-1401
(866) 393-8340
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD042369L
PA
2085R0202X
Diagnostic Radiology Physician
Primary
MD042369L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012389070048
—
PA
05
—
003566900
—
FL
05
—
057342600
—
DC
05
—
1588661904
—
CA
05
—
1588661904
—
MI
05
—
470001500
—
MD
05
—
7100356790
—
KY
01
—
G88056
MEDICAL LICENSE
CA
Enumeration date
06/30/2005
Last updated
05/24/2023
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