Organization
FAMILY PRACTICE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY A KELLY DO (OFFICE MANAGER)
(856) 231-9792
Entity
Organization
Contact information
Practice address
3814 CHURCH RD, MOUNT LAUREL, NJ 08054-1106
(856) 231-9792
Mailing address
3814 CHURCH RD, MOUNT LAUREL, NJ 08054-1106
(856) 231-9792
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
MB44700
NJ
Other
Enumeration date
01/02/2007
Last updated
08/22/2020
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