MEDICARE: PENNSAUKEN MEDICAL CENTER LLC

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	MA37577	NJ

General Provider Information

NPI Number	:	1538326228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSAUKEN MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	6024 WESTFIELD AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1720
Country	:	US
Telephone Number	:	856-663-1122
Fax Number	:	856-663-2710

Provider Business Practice Location Address
First Line	:	6024 WESTFIELD AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1720
Country	:	US
Telephone Number	:	856-663-1122
Fax Number	:	856-663-2710

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. RASHID AHMAD
Credential	:	MD
Telephone Number	:	856-663-1122

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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