MEDICARE: ISABEL HILARY PETTIGREW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA04503100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60089867	OTHER	NJ	HORIZON NJ HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1443064	OTHER	NJ	CIGNA
4	100080946302	OTHER	NJ	AMERICHOICE
5	0070964000	OTHER	NJ	AMERIHEALTH
6	8386519	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1023098225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL HILARY PETTIGREW M.D.

Provider Business Mailing Address
First Line	:	500 GROVE ST
Second Line	:	STE 100
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1761
Country	:	US
Telephone Number	:	856-796-9200
Fax Number	:	856-796-9397

Provider Business Practice Location Address
First Line	:	740 MARNE HWY
Second Line	:	STE 206
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3126
Country	:	US
Telephone Number	:	856-234-6045
Fax Number	:	856-234-0498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/01/2012

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