Healthcare Provider Details

I. General information

NPI: 1770909608
Provider Name (Legal Business Name): DOUGLAS PATRICK RHEAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W ATLANTIC AVE
HADDON HEIGHTS NJ
08035-1715
US

IV. Provider business mailing address

120 WHITE HORSE PIKE STE 112
HADDON HEIGHTS NJ
08035-1938
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-3003
  • Fax: 856-547-5337
Mailing address:
  • Phone: 856-547-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number332948
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number332948
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MB10264200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: