Provider Demographics
NPI:1912007576
Name:FAMADOR, ANNA QUILINO (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:QUILINO
Last Name:FAMADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE AGUAS
Other - Last Name:QUILINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:STE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3917
Mailing Address - Country:US
Mailing Address - Phone:856-316-0916
Mailing Address - Fax:
Practice Address - Street 1:315 ROUTE 70 E STE A
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2408
Practice Address - Country:US
Practice Address - Phone:856-375-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429823207Q00000X
NJ25MA09313400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1585117OtherGATEWAY-WMG
PA20097678OtherAMERIHEALTH MERCY-WMG
MD956405OtherCAREFIRST MD BCBS
PA2135831OtherHIGHMARK BLUE SHIELD
PA284925OtherUNISON-WMG
PA102379457Medicaid
PA30096342OtherAMERIHEALTH MERCYWMG
PA30096342OtherAMERIHEALTH MERCYWMG