Provider Demographics
NPI:1679744734
Name:JORGE L. CAMPANA, M.D., P.C.
Entity type:Organization
Organization Name:JORGE L. CAMPANA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CAMPANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-534-4277
Mailing Address - Street 1:6201 LEESBURG PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2201
Mailing Address - Country:US
Mailing Address - Phone:703-534-4277
Mailing Address - Fax:703-241-5510
Practice Address - Street 1:6201 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2201
Practice Address - Country:US
Practice Address - Phone:703-534-4277
Practice Address - Fax:703-241-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043415207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006301576Medicaid
VA006301576Medicaid
VA144576C63Medicare PIN
DC575063Medicare PIN