Healthcare Provider Details

I. General information

NPI: 1194878991
Provider Name (Legal Business Name): MARION LESLEY PATTERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 ROUTE 70 W
CHERRY HILL NJ
08002-2733
US

IV. Provider business mailing address

101 2ND ST
LAKEWOOD NJ
08701-3324
US

V. Phone/Fax

Practice location:
  • Phone: 856-406-0023
  • Fax:
Mailing address:
  • Phone: 732-363-6655
  • Fax: 732-901-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06667000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: