1790040277 NPI number — LOURDES MEDICAL ASSOCIATES, PA

Table of content: EXHALIA ASHLEY GRADY WHNP (NPI 1518670587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790040277 NPI number — LOURDES MEDICAL ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOURDES MEDICAL ASSOCIATES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790040277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 GROVE ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HADDON HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08035-1761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-796-9200
Provider Business Mailing Address Fax Number:
856-310-5603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BRACE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-470-9029
Provider Business Practice Location Address Fax Number:
856-428-4053
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-796-9200

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6535704 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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