Provider Demographics
NPI:1497701593
Name:MAGNESS-STAFFORD OB-GYN ASSOC., P.A.
Entity Type:Organization
Organization Name:MAGNESS-STAFFORD OB-GYN ASSOC., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREGGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-795-3313
Mailing Address - Street 1:1810 HADDONFIELD BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3736
Mailing Address - Country:US
Mailing Address - Phone:856-795-3313
Mailing Address - Fax:856-354-8780
Practice Address - Street 1:1810 HADDONFIELD BERLIN RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3736
Practice Address - Country:US
Practice Address - Phone:856-795-3313
Practice Address - Fax:856-354-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05303200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010867Medicare ID - Type Unspecified