Provider Demographics
NPI:1073566303
Name:SUMERSON, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:SUMERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:245 N RIDING DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1326
Mailing Address - Country:US
Mailing Address - Phone:856-608-8239
Mailing Address - Fax:
Practice Address - Street 1:1001 BRIGGS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4100
Practice Address - Country:US
Practice Address - Phone:856-866-7466
Practice Address - Fax:856-866-9088
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069153207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8636303Medicaid
NJ8636303Medicaid
NJ046802CMBMedicare ID - Type Unspecified