MEDICARE: DR. CARMEN H LEBRON 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	25MA07852900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	061691342	OTHER	NJ	TAX ID #

General Provider Information

NPI Number	:	1902872468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN H LEBRON MD

Provider Business Mailing Address
First Line	:	401 ROUTE 73 N STE 320
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3426
Country	:	US
Telephone Number	:	973-243-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 NORTHFIELD AVE STE 7
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-1136
Country	:	US
Telephone Number	:	973-243-0002
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	08/24/2022

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