Provider Demographics
NPI:1649562042
Name:ADVOCARE, LLC
Entity Type:Organization
Organization Name:ADVOCARE, LLC
Other - Org Name:ADVOCARE BERLIN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-782-3300
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:
Practice Address - Street 1:175 CROSS KEYS RD
Practice Address - Street 2:BLDG. 300 A
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9263
Practice Address - Country:US
Practice Address - Phone:856-767-0077
Practice Address - Fax:856-767-6102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification