Provider Demographics
NPI:1629266572
Name:PAUL L VERNON, MD, PA
Entity Type:Organization
Organization Name:PAUL L VERNON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-235-1211
Mailing Address - Street 1:2026 BRIGGS ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4602
Mailing Address - Country:US
Mailing Address - Phone:856-235-1211
Mailing Address - Fax:856-231-1149
Practice Address - Street 1:2026 BRIGGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4601
Practice Address - Country:US
Practice Address - Phone:856-235-1211
Practice Address - Fax:856-231-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629266572OtherRAILROAD MEDICARE
NJ1053340001Medicare NSC
045376Medicare PIN