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General NPI Number Information
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NPI Number | 1568617819
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Entity Type | Organization
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Legal Business Name | MEDAMERICA GROUP
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Dates
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Enumeration Date | 11/27/2008
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 6309 VENTNOR AVE
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City | VENTNOR CITY
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State | NJ
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Zip | 08406-2295
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Country | US
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Telephone | 609-823-0555
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Fax | 609-823-0330
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Provider Business Mailing Address
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Address Line | 8602 FULTON AVE
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City | MARGATE CITY
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State | NJ
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Zip | 08402-1410
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Country | US
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Telephone | 609-822-1604
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Fax | 609-822-1604
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARK PETER ALEXANDER
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Credential | M.D., M.B.A.
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Telephone | 913-963-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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