Healthcare Provider Details

I. General information

NPI: 1619969474
Provider Name (Legal Business Name): MITCHELL J FUHRMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 LAUREL OAK RD STE 165
VOORHEES NJ
08043-4312
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-3600
  • Fax: 856-424-7154
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA03573900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: