Individual
DANA SUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
RENAISSANCE SQUARE, 141 ROUTE 70, SUITE B, MARLTON, NJ 08053
(856) 596-9057
(856) 596-0837
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 596-9057
(856) 596-0837
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA06493000
NJ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
25MA06493000
NJ
207RP1001X
Pulmonary Disease Physician
Primary
25MA06493000
NJ
207RS0012X
Sleep Medicine (Internal Medicine) Physician
25MA06493000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8780102
—
NJ
Enumeration date
06/04/2006
Last updated
08/26/2024
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