Provider Demographics
NPI:1386682094
Name:CMC DEPARTMENT OF MEDICINE GROUP, PA
Entity Type:Organization
Organization Name:CMC DEPARTMENT OF MEDICINE GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAZZARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-968-7858
Mailing Address - Street 1:1 FEDERAL STREET
Mailing Address - Street 2:SW-200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-382-6455
Practice Address - Street 1:3 COOPER PLAZA
Practice Address - Street 2:SUITE 215
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2439
Practice Address - Fax:856-342-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2277673000OtherAMERIHLTH (RHEUMATOLOGY
NJ2265447000OtherAMERIHEALTH (NEUROLOGY)
NJ2363616000OtherAMERIHEALTH (CARDIOLOGY)
NJ2206125000OtherAMERIHLTH (HEMATOLOGY)
NJ2144779000OtherAMERIHLTH (CRITICAL CARE)
NJ2233338000OtherAMERIHEALTH (NEPHROLOGY)
NJ3040909Medicaid
NJ045673 PPDMedicare PIN
NJ2277673000OtherAMERIHLTH (RHEUMATOLOGY
NJ183652Medicare PIN
NJ045671 PPCMedicare PIN
NJ045659 PN9Medicare PIN
DEG01766Medicare PIN
NJ2233338000OtherAMERIHEALTH (NEPHROLOGY)
NJ045654 PN8Medicare PIN
NJ2206125000OtherAMERIHLTH (HEMATOLOGY)
NJ045664 PPBMedicare UPIN
NJ049041 PW2Medicare PIN
NJ045651 PN7Medicare PIN