Healthcare Provider Details

I. General information

NPI: 1255582292
Provider Name (Legal Business Name): AMERICAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 N CALVERT ST SUITE #110
BALTIMORE MD
21218-2801
US

IV. Provider business mailing address

1 ALPHA AVE SUITE 20
VOORHEES NJ
08043-1049
US

V. Phone/Fax

Practice location:
  • Phone: 410-889-5252
  • Fax: 410-889-6102
Mailing address:
  • Phone: 856-616-8836
  • Fax: 856-427-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY LUKE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 856-616-2393