Healthcare Provider Details

I. General information

NPI: 1043539943
Provider Name (Legal Business Name): LOURDES MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 BURLINGTON MOUNT HOLLY RD
BURLINGTON NJ
08016-4157
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1736
US

V. Phone/Fax

Practice location:
  • Phone: 609-747-9200
  • Fax: 609-747-1408
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-310-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MB07486200
License Number StateNJ

VIII. Authorized Official

Name: STEVEN FOX
Title or Position: PRESIDENT
Credential: MD
Phone: 856-796-9200