Individual
DR. JACK DWOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15000 MIDLANTIC DRIVE, SUITE 100, MT. LAUREL, NJ 08054
(856) 252-1000
(856) 252-1100
Mailing address
15000 MIDLANTIC DR, SUITE 100, MOUNT LAUREL, NJ 08054-1573
(856) 252-1000
(856) 252-1100
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
25MA04771800
NJ
208800000X
Urology Physician
MD064953L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055472
AETNA
—
01
—
0073781000
AMERIHEALTH
—
Enumeration date
01/30/2006
Last updated
06/23/2021
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