Provider Demographics
NPI:1467581892
Name:AGER, MARY ANN MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:MICHELE
Last Name:AGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MARLTON PIKE E # Q-11
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-751-8333
Mailing Address - Fax:856-751-3438
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:D-19
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-751-8333
Practice Address - Fax:856-751-3438
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 0445852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8865302Medicaid
NJ8865302Medicaid
NJ145141Medicare ID - Type Unspecified