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General NPI Number Information
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NPI Number | 1063404861
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Entity Type | Individual
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Provider Name | MARC H MICHELSON DO
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 151 FRIES MILL RD SUITE 400
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2016
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Country | US
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Telephone | 856-401-9300
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Fax | 856-374-5805
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Provider Business Mailing Address
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Address Line | 151 FRIES MILL RD SUITE 400
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2016
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Country | US
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Telephone | 856-401-9300
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Fax | 856-374-5805
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MB051021
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License Number State | NJ
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