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General NPI Number Information
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NPI Number | 1033426408
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Entity Type | Organization
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Legal Business Name | FENWICK EMERGENCY PHYSICIANS LLC
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 310 WOODSTOWN ROAD
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City | SALEM
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State | NJ
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Zip | 08079-2064
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Country | US
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Telephone | 856-935-1000
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Fax | 856-935-0962
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Provider Business Mailing Address
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Address Line | 13737 NOEL ROAD STE 1600
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City | PHILADELPHIA
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State | TX
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Zip | 19101
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Country | US
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Telephone | 469-401-2386
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Fax | 214-712-2444
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Authorized Official
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Title or Position | OFFICER
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Name | ROSS RONAN
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Credential |
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Telephone | 469-401-2386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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