Healthcare Provider Details

I. General information

NPI: 1922130129
Provider Name (Legal Business Name): CMC DEPARTMENT OF MEDICINE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 KINGS HWY N SUITE 202
CHERRY HILL NJ
08034-1983
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-968-7019
  • Fax: 856-482-5621
Mailing address:
  • Phone: 856-342-2921
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MCMULLEN
Title or Position: EVP MANAGED CARE
Credential:
Phone: 856-342-2921