Healthcare Provider Details

I. General information

NPI: 1033216163
Provider Name (Legal Business Name): ALAN D. DENNISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MARTER AVE BLDG 500, SUITE 503
MOORESTOWN NJ
08057-3124
US

IV. Provider business mailing address

110 MARTER AVE BLDG 500, SUITE 503
MOORESTOWN NJ
08057-3124
US

V. Phone/Fax

Practice location:
  • Phone: 856-608-8840
  • Fax: 856-722-1898
Mailing address:
  • Phone: 856-608-8840
  • Fax: 856-722-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA65290
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD066265L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: