Healthcare Provider Details

I. General information

NPI: 1598754400
Provider Name (Legal Business Name): RANDOLPH DEGER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DRIVE SUITE E315
VOORHEES NJ
08043-4520
US

IV. Provider business mailing address

7000 ATRIUM WAY SUITE 6
MOUNT LAUREL NJ
08054
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7310
  • Fax: 856-247-7309
Mailing address:
  • Phone: 856-291-6818
  • Fax: 856-291-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MA07854700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: