MEDICARE: MICHAEL C. DIMARCANGELO JR. D.O.

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	25MB04884500	NJ

General Provider Information

NPI Number	:	1881673275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C. DIMARCANGELO JR. D.O.

Provider Business Mailing Address
First Line	:	303 HIALEAH DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-5706
Country	:	US
Telephone Number	:	609-779-7386
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 W MAIN ST
Second Line	:	SUITE C
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2411
Country	:	US
Telephone Number	:	856-779-7386
Fax Number	:	856-779-7563

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	04/25/2022

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