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NPI Code Detail

MEDICARE: DR. ROBERT CHRISTOPHER TYRRELL DPM

MEDICARE: DR. ROBERT CHRISTOPHER TYRRELL DPM
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
1213EP1101XPrimary Podiatric Medicine Podiatrist25MD00180000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10114943000OTHERNJAMERIHEALTH
2441295OTHERNJUNITED HEALTHCARE
30928309OTHERNJAETNA
4E34136OTHERNJAMERIHEALTH ADMINITRATORS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
62232722520OTHERNJHORIZON BLUE SHIELD NJ
7000534136OTHERNJHIGHMARK BLUE SHIELD PA

General Provider Information

NPI Number : 1912906561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT CHRISTOPHER TYRRELL DPM
Provider Business Mailing Address
First Line : 44 MELROSE AVE
Second Line :
City : HADDON TOWNSHIP
State : NJ
Zip : 08108-2314
Country : US
Telephone Number : 856-869-0202
Fax Number : 856-869-8159
Provider Business Practice Location Address
First Line : 2250 CHAPEL AVE W STE 130
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08002-2051
Country : US
Telephone Number : 856-663-3733
Fax Number : 856-663-3660
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2005
Last Update Date : 08/11/2015

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