MEDICARE: COLLINGSWOOD FAMILY MEDICINE, P.A.

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

General Provider Information

NPI Number	:	1588601967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINGSWOOD FAMILY MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	275 HADDON AVE
Second Line	:	COLLINGSWOOD MEDICAL CENTER
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-1121
Country	:	US
Telephone Number	:	856-858-3375
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 HADDON AVE
Second Line	:	COLLINGSWOOD MEDICAL CENTER
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-1121
Country	:	US
Telephone Number	:	856-858-3375
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR/PHYSICIAN
Name	:	DR. JASON N MORALEDA
Credential	:	M.D.
Telephone Number	:	856-858-3375

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/01/2010

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