Organization
CMC DEPT OF MEDICINE GROUP PA
Active
Organization
CMC DEPT OF MEDICINE GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCMULLEN (EVP MANAGED CARE)
(856) 342-2921
Entity
Organization
Contact information
Practice address
14 S BROADWAY, GLOUCESTER CITY, NJ 08030-1706
(856) 456-0518
(856) 456-4359
Mailing address
3 COOPER PLZ, SUITE 502, CAMDEN, NJ 08103-1438
(856) 342-2921
(856) 968-8499
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2821317000
AMERIHEALTH GRP#
NJ
Enumeration date
04/19/2007
Last updated
05/05/2009
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