Healthcare Provider Details

I. General information

NPI: 1134127111
Provider Name (Legal Business Name): DAVID P AVELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR FL 2
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

102 E CENTRE BLVD
MARLTON NJ
08053-4129
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-6260
  • Fax:
Mailing address:
  • Phone: 856-988-6260
  • Fax: 856-988-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMA58666
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA05866600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: