Provider Demographics
NPI:1629040365
Name:VANDEERLIN, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:VANDEERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0536
Mailing Address - Country:US
Mailing Address - Phone:856-435-8362
Mailing Address - Fax:856-435-4381
Practice Address - Street 1:400 LIPPINCOTT DR
Practice Address - Street 2:SUITE 130
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4161
Practice Address - Country:US
Practice Address - Phone:856-596-2233
Practice Address - Fax:856-596-2411
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA065543207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF80763Medicare UPIN