MEDICARE: BARBARA GLEESON MSN, APN, C

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	26NN07371500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922087311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA GLEESON MSN, APN, C

Provider Business Mailing Address
First Line	:	401 ROUTE 73 NORTH 40 LAKE CENTER DRIVE
Second Line	:	SUITE 201A
City	:	MARLTON
State	:	NJ
Zip	:	08053-3425
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-355-0360

Provider Business Practice Location Address
First Line	:	6981 N PARK DR
Second Line	:	COOPER RIVER WEST OFFICE BUILDING
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-4205
Country	:	US
Telephone Number	:	856-663-4949
Fax Number	:	856-663-6076

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	10/19/2020

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