MEDICARE: MERCERVILLE MEDICAL ASSOC PC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1972592129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCERVILLE MEDICAL ASSOC PC

Provider Business Mailing Address
First Line	:	3800 QUAKERBRIDGE RD
Second Line	:
City	:	MERCERVILLE
State	:	NJ
Zip	:	08619-1010
Country	:	US
Telephone Number	:	609-890-6100
Fax Number	:	609-586-0399

Provider Business Practice Location Address
First Line	:	3800 QUAKERBRIDGE RD
Second Line	:
City	:	MERCERVILLE
State	:	NJ
Zip	:	08619-1010
Country	:	US
Telephone Number	:	609-890-6100
Fax Number	:	609-586-0399

Authorized Official
Title or Position	:	SECRETARY/CREDENTIALING/REFERRALS
Name	:	BONNIE L HARTZ
Credential	:
Telephone Number	:	609-890-6100

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	08/22/2020

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