Healthcare Provider Details

I. General information

NPI: 1881147197
Provider Name (Legal Business Name): LOURDES MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WHITEHORSE MERCERVILLE RD SUITE 203
HAMILTON NJ
08619-3882
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 609-581-6060
  • Fax:
Mailing address:
  • Phone: 856-796-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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