MEDICARE: ATLANTICARE PHYSICIAN GROUP

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1790799096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTICARE PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	2500 ENGLISH CREEK AVE
Second Line	:	BULDING B
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-5549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S WHITE HORSE PIKE
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-1804
Country	:	US
Telephone Number	:	609-407-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. DONALD J PARKER
Credential	:	MSW
Telephone Number	:	609-272-6393

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	12/31/2007

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