Healthcare Provider Details

I. General information

NPI: 1366532723
Provider Name (Legal Business Name): ROBERT F OSTRUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 408
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 408
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-968-7363
  • Fax: 856-968-8288
Mailing address:
  • Phone: 856-968-7363
  • Fax: 856-968-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA07520600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: