Healthcare Provider Details

I. General information

NPI: 1003024852
Provider Name (Legal Business Name): THOMAS DENTON DEMARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 307
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

525 NEWTON LAKE DR APT# D-420
COLLINGSWOOD NJ
08107-1616
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2328
  • Fax: 856-541-6137
Mailing address:
  • Phone: 856-869-4569
  • Fax: 856-541-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTEMPORARY
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: