Healthcare Provider Details

I. General information

NPI: 1487631933
Provider Name (Legal Business Name): OLLMC NEONATAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE ICN
CAMDEN NJ
08103-3101
US

IV. Provider business mailing address

1600 HADDON AVE ICN
CAMDEN NJ
08103-3101
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3988
  • Fax:
Mailing address:
  • Phone: 856-757-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARGARET C FERNANDES
Title or Position: MEDICAL DIRECTOR
Credential: M. D.
Phone: 856-757-3988