Healthcare Provider Details

I. General information

NPI: 1952342990
Provider Name (Legal Business Name): UNDERWOOD-MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEXINGTON RD BLDG 1
WOOLWICH TOWNSHIP NJ
08085-1276
US

IV. Provider business mailing address

1120 DELSEA DR N
GLASSBORO NJ
08028-1444
US

V. Phone/Fax

Practice location:
  • Phone: 856-467-7360
  • Fax: 856-467-5959
Mailing address:
  • Phone: 856-686-5480
  • Fax: 856-686-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFACILITY10801
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN W. GRAHAM
Title or Position: EXEC.VP/ COO
Credential:
Phone: 856-845-0100