Healthcare Provider Details

I. General information

NPI: 1114011962
Provider Name (Legal Business Name): TERESA J HUMARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/21/2008
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

3 COOPER PLZ SUITE 307
CAMDEN NJ
08103-1438
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA077045
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: