MEDICARE: TRUE NORTH MEDICAL GROUP, LLC

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	207Q00000X	Family Medicine Physician
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1750929907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE NORTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1673
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-7673
Country	:	US
Telephone Number	:	856-470-4776
Fax Number	:	856-624-3572

Provider Business Practice Location Address
First Line	:	2510 MARYLAND RD STE 160
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1137
Country	:	US
Telephone Number	:	215-672-6622
Fax Number	:	215-672-6566

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JACOB PELTZMAN
Credential	:
Telephone Number	:	856-470-4776

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	06/16/2021

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