Healthcare Provider Details

I. General information

NPI: 1356644553
Provider Name (Legal Business Name): LOURDES MEDICAL ASSOCIATES, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD SUITE C
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-470-9029
  • Fax: 856-428-4053
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-310-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MA08956900
License Number StateNJ

VIII. Authorized Official

Name: STEVEN FOX
Title or Position: PRESIDENT
Credential: M. D.
Phone: 856-796-9200