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
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568632354
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	:	08035-1702
Country	:	US
Telephone Number	:	856-796-9200
Fax Number	:	856-796-9397

Provider Business Practice Location Address
First Line	:	1055 HADDON AVE
Second Line	:
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-2047
Country	:	US
Telephone Number	:	856-854-4524
Fax Number	:	856-854-8216

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN FOX
Credential	:
Telephone Number	:	856-796-9200

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	11/10/2014

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