Healthcare Provider Details

I. General information

NPI: 1528722543
Provider Name (Legal Business Name): CEREBRAL MEDICAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BEAR TAVERN RD STE 305
EWING NJ
08628-1021
US

IV. Provider business mailing address

2093 PHILADELPHIA PIKE # 9898
CLAYMONT DE
19703-2424
US

V. Phone/Fax

Practice location:
  • Phone: 415-403-2156
  • Fax: 415-651-3458
Mailing address:
  • Phone: 415-403-2156
  • Fax: 415-651-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BOGGS
Title or Position: PRESIDENT
Credential: MD
Phone: 415-489-9369