Healthcare Provider Details

I. General information

NPI: 1902826241
Provider Name (Legal Business Name): DELAWARE VALLEY UROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 MIDLANTIC DRIVE
MOUNT LAUREL NJ
08054
US

IV. Provider business mailing address

10000 MIDLANTIC DRIVE
MOUNT LAUREL NJ
08054
US

V. Phone/Fax

Practice location:
  • Phone: 856-985-8000
  • Fax: 856-985-1600
Mailing address:
  • Phone: 856-985-8000
  • Fax: 856-985-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: JOHN M MURPHY
Title or Position: CEO, CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 856-985-8000