Provider Demographics
NPI:1134646268
Name:CLAUDINE M DE DAN MD LLC
Entity Type:Organization
Organization Name:CLAUDINE M DE DAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE DAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-628-8120
Mailing Address - Street 1:34 COLSON LN STE B
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1502
Mailing Address - Country:US
Mailing Address - Phone:856-628-8120
Mailing Address - Fax:856-628-8123
Practice Address - Street 1:34 COLSON LN STE B
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1502
Practice Address - Country:US
Practice Address - Phone:856-628-8120
Practice Address - Fax:856-628-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07871700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty