Provider Demographics
NPI:1598754400
Name:DEGER, RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:DEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:200 BOWMAN DRIVE
Practice Address - Street 2:SUITE E315
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4520
Practice Address - Country:US
Practice Address - Phone:856-247-7310
Practice Address - Fax:856-247-7309
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07854700207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069426Medicaid
NJF67029Medicare UPIN
NJ091743YBAWMedicare PIN
NJ091743R63Medicare PIN