Healthcare Provider Details

I. General information

NPI: 1801066402
Provider Name (Legal Business Name): LOURDES MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 HADDON AVE
CAMDEN NJ
08103-3109
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1702
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3700
  • Fax: 856-310-5603
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-310-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB07677000
License Number StateNJ

VIII. Authorized Official

Name: LINDA ROSENSON
Title or Position: CFO
Credential:
Phone: 856-796-9200