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NPI Code Detail

MEDICARE: LOURDES MEDICAL ASSOCIATES, PA

MEDICARE: LOURDES MEDICAL ASSOCIATES, PA
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
12084N0400XNeurology Physician
2207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1164975488
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOURDES MEDICAL ASSOCIATES, PA
Provider Business Mailing Address
First Line : 500 GROVE ST
Second Line : SUITE 100
City : HADDON HEIGHTS
State : NJ
Zip : 08035-1761
Country : US
Telephone Number : 856-796-0200
Fax Number :
Provider Business Practice Location Address
First Line : 820 BEAR TAVERN RD
Second Line :
City : EWING
State : NJ
Zip : 08628-1021
Country : US
Telephone Number : 609-882-5400
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : STEVEN FOX
Credential : M.D
Telephone Number : 856-796-9200
Provider Enumeration Date : 08/03/2016
Last Update Date : 08/03/2016

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Directions to “LOURDES MEDICAL ASSOCIATES, PA ” Practice Location

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