Basic Information
| Provider Information | |||||||||
| NPI: | 1851371991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CIERVO | ||||||||
| FirstName: | CARMAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 N MAPLE AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565960558 | ||||||||
| FaxNumber: | 8565964043 | ||||||||
| Practice Location | |||||||||
| Address1: | 73 N MAPLE AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565960558 | ||||||||
| FaxNumber: | 8565964043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB05355700 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.