Healthcare Provider Details

I. General information

NPI: 1144312703
Provider Name (Legal Business Name): INTEGRATED FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 BRICK RD SUITE 105
MARLTON NJ
08053-2179
US

IV. Provider business mailing address

701 COOPER RD SUITE 16
VOORHEES NJ
08043-3800
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-0444
  • Fax:
Mailing address:
  • Phone: 856-783-5000
  • Fax: 856-783-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MB05704400
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT A DAVIS
Title or Position: PRESIDENT
Credential: DO
Phone: 856-783-5000