Provider Demographics
NPI:1326025404
Name:COSS, WANDA I (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:I
Last Name:COSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:520 STOKES RD
Practice Address - Street 2:IRONSTONE BUILDING B10
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2904
Practice Address - Country:US
Practice Address - Phone:609-654-9112
Practice Address - Fax:609-654-7404
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06285700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6695809Medicaid
I19419Medicare UPIN