Healthcare Provider Details

I. General information

NPI: 1831300243
Provider Name (Legal Business Name): MEREDITH CRISP DUFFY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COOPER PLZ 400 HADDON AVE
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 FEDERAL ST STE SW200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 855-632-2667
  • Fax: 856-325-6643
Mailing address:
  • Phone: 856-968-7433
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMA08274000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME90899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: