Provider Demographics
NPI:1659457844
Name:CAMPBELL, RUTH ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ELIZABETH
Other - Last Name:PINKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:EASTERN CORRECTIONAL INSTITUTION
Mailing Address - Street 2:30420 REVELLS NECK RD
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21890
Mailing Address - Country:US
Mailing Address - Phone:410-845-4000
Mailing Address - Fax:410-845-4134
Practice Address - Street 1:EASTERN CORRECTIONAL INSTITUTION
Practice Address - Street 2:30420 REVELLS NECK RD
Practice Address - City:WESTOVER
Practice Address - State:MD
Practice Address - Zip Code:21890
Practice Address - Country:US
Practice Address - Phone:410-845-4000
Practice Address - Fax:410-845-4134
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCDFXMedicare ID - Type Unspecified
P70936Medicare UPIN