Healthcare Provider Details

I. General information

NPI: 1275362105
Provider Name (Legal Business Name): MERIDIAN MEDICAL GROUP - SPECIALTY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 EDGEWATER TOWNE CTR
EDGEWATER NJ
07020-1246
US

IV. Provider business mailing address

PO BOX 95000-8923
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-689-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES ALOYSIUS CLARKE
Title or Position: EVP AND PRESIDENT PHYSICIAN ENTERPR
Credential:
Phone: 732-765-6317