Provider Demographics
NPI: | 1649226515 |
---|---|
Name: | VIRTUA MEDICAL GROUP, PA |
Entity Type: | Organization |
Organization Name: | VIRTUA MEDICAL GROUP, PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EVP, CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | MARK |
Authorized Official - Last Name: | MATSINGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 856-355-0340 |
Mailing Address - Street 1: | 301 LIPPINCOTT DR STE 410 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARLTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08053-4197 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-355-0340 |
Mailing Address - Fax: | 856-355-0330 |
Practice Address - Street 1: | 301 LIPPINCOTT DR STE 410 |
Practice Address - Street 2: | |
Practice Address - City: | MARLTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08053-4197 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-355-0340 |
Practice Address - Fax: | 856-355-0330 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-25 |
Last Update Date: | 2023-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RT0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | Group - Multi-Specialty |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0105X | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0232351 | Medicaid | |
NJ | 0222135 | Medicaid |