Provider Demographics
NPI:1477528529
Name:KOERNER, DAVID MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:KOERNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:
Practice Address - Street 1:102 WHITE HORSE RD W
Practice Address - Street 2:SUITE 102
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3610
Practice Address - Country:US
Practice Address - Phone:856-783-6200
Practice Address - Fax:856-783-8434
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB066495207Q00000X
NJ25MB06649500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8326401Medicaid
NJ8326401Medicaid
NJH25408Medicare UPIN