Healthcare Provider Details

I. General information

NPI: 1770538696
Provider Name (Legal Business Name): ADVOCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 856-872-7055
  • Fax:
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN M CANDIA
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 856-872-7053