Provider Demographics
NPI:1013958875
Name:TENCH, MAVOLA (MD)
Entity Type:Individual
Prefix:MS
First Name:MAVOLA
Middle Name:
Last Name:TENCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 DELSEA DR N
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1444
Mailing Address - Country:US
Mailing Address - Phone:856-582-0500
Mailing Address - Fax:856-582-0163
Practice Address - Street 1:1120 DELSEA DR N
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1444
Practice Address - Country:US
Practice Address - Phone:856-582-0500
Practice Address - Fax:856-582-0163
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06318700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6971601Medicaid
NJ875770C34Medicare PIN
NJG36964Medicare UPIN