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General NPI Number Information
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NPI Number | 1548454903
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Entity Type | Organization
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Legal Business Name | PENNSALEM MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 244 N BROADWAY
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City | PENNSVILLE
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State | NJ
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Zip | 08070-1228
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Country | US
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Telephone | 856-678-9200
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Fax | 856-678-8400
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Provider Business Mailing Address
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Address Line | 244 N BROADWAY P O BOX248
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City | PENNSVILLE
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State | NJ
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Zip | 08070-1228
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Country | US
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Telephone | 856-678-9200
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Fax | 856-678-8400
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. UDAY S UTHAMAN
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Credential | M.D.
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Telephone | 856-678-9200
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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 | 25MA05838200
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License Number State | NJ
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