Healthcare Provider Details

I. General information

NPI: 1982609889
Provider Name (Legal Business Name): JAMES M. SUMERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N KINGS HWY SUITE 201
CHERRY HILL NJ
08034-1906
US

IV. Provider business mailing address

P.O. BOX 48158
NEWARK NJ
07101-8358
US

V. Phone/Fax

Practice location:
  • Phone: 856-667-1575
  • Fax: 856-667-3020
Mailing address:
  • Phone: 856-667-1575
  • Fax: 856-667-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA02581000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: