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General NPI Number Information
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NPI Number | 1841783438
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Entity Type | Individual
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Provider Name | DYLAN JAMES MCDIVITT DO
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Gender | Male
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 125 EAST AVE STE C
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City | WOODSTOWN
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State | NJ
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Zip | 08098-1351
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Country | US
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Telephone | 856-769-2800
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Fax | 856-769-4256
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Provider Business Mailing Address
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Address Line | 786 CARTERET CT
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-3205
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Country | US
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Telephone | 856-641-8000
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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 | 25MB10990100
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License Number State | NJ
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