Provider Demographics
NPI:1306372578
Name:ADVOCARE ALLIED GASTROINTESTINAL ASSOCIATES
Entity Type:Organization
Organization Name:ADVOCARE ALLIED GASTROINTESTINAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-872-7055
Mailing Address - Street 1:401 ROUTE 73 N, BLDG 10, STE 320
Mailing Address - Street 2:LAKE CENTER EXECUTIVE PARK
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-872-7052
Mailing Address - Fax:856-762-1775
Practice Address - Street 1:401 ROUTE 73 N, BLDG 10, STE 320
Practice Address - Street 2:LAKE CENTER EXECUTIVE PARK
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-872-7052
Practice Address - Fax:856-762-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty