Individual
BETHANY RENEE CANVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
390 N BROADWAY BLDG STE 100, PENNSVILLE, NJ 08070-1253
(856) 678-6411
Mailing address
1 FEDERAL ST STE 200, CAMDEN, NJ 08103-1088
(848) 288-6935
(732) 790-0107
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA11541400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004217099
—
CT
05
—
008039745
—
CT
05
—
008056033
—
CT
05
—
008056168
—
CT
05
—
008068298
—
CT
05
—
008103365
—
CT
Enumeration date
05/09/2018
Last updated
06/25/2024
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