Healthcare Provider Details

I. General information

NPI: 1487955647
Provider Name (Legal Business Name): LOURDES MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 EGG HARBOR RD SUITE B5
SEWELL NJ
08080-2359
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 856-795-9200
  • Fax: 856-354-6069
Mailing address:
  • Phone: 856-796-9255
  • Fax: 856-310-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN FOX
Title or Position: PRESIDENT
Credential: MD
Phone: 856-796-9200