Individual
TARA L. WYCHE-BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
485 WILLIAMSTOWN RD, SICKLERVILLE, NJ 08081-1777
(856) 237-8100
(856) 237-8042
Mailing address
155 BRIDGETON PIKE, MULLICA HILL, NJ 08062-2669
(856) 223-0500
(856) 223-1098
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA07694800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2030554
CIGNA
NJ
01
—
304846
AMERIGROUP
NJ
Enumeration date
07/20/2006
Last updated
01/07/2022
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