Provider Demographics
NPI:1619176443
Name:VIRTUA HEALTH INC
Entity Type:Organization
Organization Name:VIRTUA HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-2000
Mailing Address - Street 1:20 W STOW RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 ROUTE 73 N
Practice Address - Street 2:50 LAKE CENTER DRIVE SUITE 401
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3425
Practice Address - Country:US
Practice Address - Phone:856-355-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUA HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-12
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ56880OtherMEDICARE HOME OFFICE PROV