MEDICARE: NORTH DOVER OB-GYN ASSOCIATES

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	207V00000X	Obstetrics & Gynecology Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0116070000	OTHER	NJ	AMERIHEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821039785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DOVER OB-GYN ASSOCIATES

Provider Business Mailing Address
First Line	:	222 OAK AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3348
Country	:	US
Telephone Number	:	732-914-1919
Fax Number	:	732-341-3303

Provider Business Practice Location Address
First Line	:	222 OAK AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3348
Country	:	US
Telephone Number	:	732-914-1919
Fax Number	:	732-341-3303

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN R. J. SUTHERLAND
Credential	:	MD
Telephone Number	:	732-914-1919

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/21/2022

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