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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