Basic Information
| Provider Information | |||||||||
| NPI: | 1740209774 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRITICAL CARE ASSOCIATES OF DELAWARE VALLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080342504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564291800 | ||||||||
| FaxNumber: | 8564291081 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080342504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564291800 | ||||||||
| FaxNumber: | 8564291081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | POPE | ||||||||
| AuthorizedOfficialFirstName: | NATALIE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8564291800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0069485 | 05 | NJ | MEDICAID |