MEDICARE: VIRTUA OUR LADY OF LOURDES HOSPITAL, INC.

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	273Y00000X	Rehabilitation Hospital Unit	10404	NJ

General Provider Information

NPI Number	:	1255336731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUA OUR LADY OF LOURDES HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	406 LIPPINCOTT DR STE J
Second Line	:	ATTN: CHRISTINE GORDON
City	:	MARLTON
State	:	NJ
Zip	:	08053-4168
Country	:	US
Telephone Number	:	856-355-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 HADDON AVENUE
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-3101
Country	:	US
Telephone Number	:	856-580-6330
Fax Number	:	856-635-2400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISA FERRARO
Credential	:
Telephone Number	:	568-886-5372

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/15/2025

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