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General NPI Number Information
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NPI Number | 1245225366
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Entity Type | Individual
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Provider Name | THEODORE G KOERNER DO
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4911 BLACK HORSE PIKE (RT 42)
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1730
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Country | US
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Telephone | 856-227-7048
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-0877
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Country | US
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Telephone | 856-227-7048
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB031874
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License Number State | NJ
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