MEDICARE: DR. NADIRA M FERNANDEZ MD

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	208000000X	Pediatrics Physician	25MA11444300	NJ

General Provider Information

NPI Number	:	1366004061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADIRA M FERNANDEZ MD

Provider Business Mailing Address
First Line	:	404 LIPPINCOTT DR
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4112
Country	:	US
Telephone Number	:	856-782-3300
Fax Number	:	856-504-8029

Provider Business Practice Location Address
First Line	:	508 HAMBURG TPKE STE 106
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8482
Country	:	US
Telephone Number	:	973-942-7800
Fax Number	:	973-942-9680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	03/12/2026

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