Provider Demographics
NPI:1851371991
Name:CIERVO, CARMAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:CARMAN
Middle Name:A
Last Name:CIERVO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 N MAPLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1782
Mailing Address - Country:US
Mailing Address - Phone:856-596-0558
Mailing Address - Fax:856-596-4043
Practice Address - Street 1:73 N MAPLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1782
Practice Address - Country:US
Practice Address - Phone:856-596-0558
Practice Address - Fax:856-596-4043
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05355700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine