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General NPI Number Information
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NPI Number | 1114151685
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Entity Type | Organization
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Legal Business Name | LOURDES MEDICAL ASSOCIATES, P. A.
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 811 SUNSET RD SUITE 201
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City | BURLINGTON
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State | NJ
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Zip | 08016-3645
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Country | US
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Telephone | 609-298-1776
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Fax | 609-531-2391
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Provider Business Mailing Address
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Address Line | 500 GROVE ST SUITE 100
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1736
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Country | US
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Telephone | 856-796-9200
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Fax | 856-310-5603
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN FOX
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Credential | MD
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Telephone | 856-796-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 25MA05310200
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License Number State | NJ
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