Healthcare Provider Details

I. General information

NPI: 1184174849
Provider Name (Legal Business Name): VIRTUA MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 180 FRONT
MOORESTOWN NJ
08057-3139
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8600
  • Fax: 856-291-8610
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN MARK MATSINGER
Title or Position: EVP; CHIEF OPERATING OFFICER
Credential: DO
Phone: 856-355-0340