Provider Demographics
NPI:1528365186
Name:UNITY CARE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:UNITY CARE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MIRMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA
Authorized Official - Phone:609-238-0870
Mailing Address - Street 1:264 CROSS KEYS RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9435
Mailing Address - Country:US
Mailing Address - Phone:856-767-3913
Mailing Address - Fax:
Practice Address - Street 1:12000 LINCOLN DR W
Practice Address - Street 2:SUITE 311
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3402
Practice Address - Country:US
Practice Address - Phone:856-985-8100
Practice Address - Fax:856-985-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty