Healthcare Provider Details

I. General information

NPI: 1477723245
Provider Name (Legal Business Name): LOURDES MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 MARNE HWY STE 100C
MOORESTOWN NJ
08057-3128
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 856-234-9006
  • Fax: 856-234-9233
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-796-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MA05473800
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN FOX
Title or Position: PRESIDENT
Credential: MD
Phone: 865-796-9200