Organization
MD MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WICKERSHAM (JR MEMBER)
(908) 309-5992
Entity
Organization
Contact information
Practice address
68 1ST AVE STE C, ATLANTIC HIGHLANDS, NJ 07716-1288
(908) 309-5992
Mailing address
68 1ST AVE STE C, ATLANTIC HIGHLANDS, NJ 07716-1288
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
03/23/2021
Last updated
03/25/2021
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