Healthcare Provider Details

I. General information

NPI: 1770560815
Provider Name (Legal Business Name): COURTNEY M MALCARNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 HADDON AVE
COLLINGSWOOD NJ
08108-2047
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1702
US

V. Phone/Fax

Practice location:
  • Phone: 856-854-4524
  • Fax:
Mailing address:
  • Phone: 856-796-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number25MA01932900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: