Provider Demographics
NPI:1033216163
Name:DENNISON, ALAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:DENNISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:BLDG 500, SUITE 503
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-608-8840
Mailing Address - Fax:856-722-1898
Practice Address - Street 1:110 MARTER AVE
Practice Address - Street 2:BLDG 500, SUITE 503
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3124
Practice Address - Country:US
Practice Address - Phone:856-608-8840
Practice Address - Fax:856-722-1898
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65290207Q00000X
PAMD066265L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010002189OtherAMERICHOICE
0523170000OtherAMERIHEALTH, KEYSTONE, IBC
NJ080128745OtherRR MEDICARE
3K4985OtherHEALTHNET
P700755OtherOXFORD
263782OtherAMERIHEALTH PPO
263786OtherPA BLUE SHIELD
1082857OtherHORIZON NJ HEALTH
799493OtherAETNA
19328OtherUNIVERSITY HEALTHPLAN
1839799OtherUNITED HEALTHCARE
6610430OtherCIGNA
NJ7581807Medicaid
010002189OtherAMERICHOICE
0523170000OtherAMERIHEALTH, KEYSTONE, IBC