MEDICARE: ATLANTICARE PHYSICIAN GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1194839910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTICARE PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	2500 ENGLISH CREEK AVE
Second Line	:	BUILDING B
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-5549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7313 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1958
Country	:	US
Telephone Number	:	609-441-2199
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. DONALD J PARKER
Credential	:
Telephone Number	:	609-272-6393

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/04/2007

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