Provider Demographics
NPI:1164469383
Name:DWYER, JAMES P (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:DWYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 E. EVESHAM ROAD
Mailing Address - Street 2:BLDG 800, SUITE 115
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4509
Mailing Address - Country:US
Mailing Address - Phone:856-424-5005
Mailing Address - Fax:856-424-4716
Practice Address - Street 1:2301 E. EVESHAM ROAD
Practice Address - Street 2:BLDG 800, SUITE 115
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-424-5005
Practice Address - Fax:856-424-4716
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03496200207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4987501Medicaid
NJC55661Medicare UPIN
NJ520348BHKMedicare ID - Type Unspecified