Healthcare Provider Details

I. General information

NPI: 1912991795
Provider Name (Legal Business Name): MINDY J DICKERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDY JILL FINK MD

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2900
  • Fax:
Mailing address:
  • Phone: 848-288-6935
  • Fax: 732-790-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberC1-0012274
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD437867
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA10175300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: