Healthcare Provider Details

I. General information

NPI: 1003190752
Provider Name (Legal Business Name): ADVOCARE MAGNESS & STAFFORD OBGYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 HADDONFIELD BERLIN RD
CHERRY HILL NJ
08003-3736
US

IV. Provider business mailing address

401 ROUTE 73 N BUILDING 10, SUITE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3313
  • Fax: 856-354-8780
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES MCQUEARY
Title or Position: EXECUTIVE VICE PRESIDENT AND COO
Credential:
Phone: 856-872-7055