Healthcare Provider Details

I. General information

NPI: 1194911172
Provider Name (Legal Business Name): US MEDGROUP OF NEW JERSEY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 CORPORATE BLVD SUITE A
LINTHICUM MD
21090-2227
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST TOWER
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 888-809-3214
  • Fax: 410-850-4264
Mailing address:
  • Phone: 800-232-3550
  • Fax: 866-465-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. W TOM FOGARTY
Title or Position: EVP, CMO
Credential: MD
Phone: 800-232-3550