Provider Demographics
NPI:1114151685
Name:LOURDES MEDICAL ASSOCIATES, P. A.
Entity Type:Organization
Organization Name:LOURDES MEDICAL ASSOCIATES, P. A.
Other - Org Name:LMA PULMONARY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-796-9200
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1736
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-310-5603
Practice Address - Street 1:811 SUNSET RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3645
Practice Address - Country:US
Practice Address - Phone:609-298-1776
Practice Address - Fax:609-531-2391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOURDES MEDICAL ASSOCIATES, P. A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-12
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05310200207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6535704Medicaid
NJ683572Medicare PIN