Provider Demographics
NPI:1235321803
Name:ALPHA MEDICAL CENTERS PC
Entity Type:Organization
Organization Name:ALPHA MEDICAL CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:PUTIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-755-3500
Mailing Address - Street 1:800 N KINGS HWY STE 410
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1511
Mailing Address - Country:US
Mailing Address - Phone:856-755-3500
Mailing Address - Fax:856-755-3552
Practice Address - Street 1:800 N KINGS HWY STE 410
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1511
Practice Address - Country:US
Practice Address - Phone:856-755-3500
Practice Address - Fax:856-755-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
074069Q2AMedicare PIN