Provider Demographics
NPI:1912218439
Name:CAPE ATLANTIC INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:CAPE ATLANTIC INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-471-3524
Mailing Address - Street 1:560 N ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1323
Mailing Address - Country:US
Mailing Address - Phone:609-471-3524
Mailing Address - Fax:609-926-4177
Practice Address - Street 1:518 SEA ISLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1039
Practice Address - Country:US
Practice Address - Phone:609-471-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty