Provider Demographics
NPI:1790714913
Name:MARLTON NEPHROLOGY AND HYPERTENSION LLC
Entity Type:Organization
Organization Name:MARLTON NEPHROLOGY AND HYPERTENSION LLC
Other - Org Name:MARLTON NEPHROLOGY & HYPERTENSION, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:AURHORIZED OFFICIAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-988-8800
Mailing Address - Street 1:775 ROUTE 70 E STE F120A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2357
Mailing Address - Country:US
Mailing Address - Phone:856-988-8800
Mailing Address - Fax:856-988-8804
Practice Address - Street 1:775 ROUTE 70 E STE F120A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2357
Practice Address - Country:US
Practice Address - Phone:856-988-8800
Practice Address - Fax:856-988-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102398Medicare PIN