Individual
DR. ERIC ROBERT REQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1001 ROUTE 73 N LOWR LEVEL, MARLTON, NJ 08053-4524
(844) 908-5483
(856) 355-7106
Mailing address
2000 CRAWFORD PL STE 200, MOUNT LAUREL, NJ 08054-3954
(856) 355-0340
(856) 355-0330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS017463
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
25MB09913200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103025113
—
PA
05
—
103056183
—
PA
Enumeration date
04/10/2012
Last updated
10/15/2020
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