MEDICARE: CMC DEPT OF MEDICINE GROUP 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2821317000	OTHER	NJ	AMERIHEALTH GRP#

General Provider Information

NPI Number	:	1518184811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMC DEPT OF MEDICINE GROUP PA

Provider Business Mailing Address
First Line	:	3 COOPER PLZ
Second Line	:	SUITE 502
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1438
Country	:	US
Telephone Number	:	856-342-2921
Fax Number	:	856-968-8499

Provider Business Practice Location Address
First Line	:	14 S BROADWAY
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1706
Country	:	US
Telephone Number	:	856-456-0518
Fax Number	:	856-456-4359

Authorized Official
Title or Position	:	EVP MANAGED CARE
Name	:	ROBERT MCMULLEN
Credential	:
Telephone Number	:	856-342-2921

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	05/05/2009

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Directions to “CMC DEPT OF MEDICINE GROUP PA ” Practice Location

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