MEDICARE: DR. HEIDI J WEINROTH MD

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	208000000X	Pediatrics Physician	25MA06484800	NJ

General Provider Information

NPI Number	:	1598713752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI J WEINROTH MD

Provider Business Mailing Address
First Line	:	3 COOPER PLZ
Second Line	:	SUITE 500
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1438
Country	:	US
Telephone Number	:	856-342-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 MARTER AVE
Second Line	:	SUITE 503
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3124
Country	:	US
Telephone Number	:	856-608-8840
Fax Number	:	856-722-1898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/26/2015

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