=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578542965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARTHUR MCDERMET D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2006
-----------------------------------------------------
Last Update Date | 10/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6981 N PARK DR COOPER RIVER WEST OFFICE BUILDING, STE 200
-----------------------------------------------------
City | PENNSAUKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08109-4205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-663-4949
-----------------------------------------------------
Fax | 856-663-6076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 LAKE CTR 401 ROUTE 73 NORTH SUITE 201A
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-355-0340
-----------------------------------------------------
Fax | 856-355-0346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25MB05670700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------