Provider Demographics
NPI:1023098225
Name:PETTIGREW, ISABEL HILARY (MD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:HILARY
Last Name:PETTIGREW
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 1:500 GROVE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:740 MARNE HWY
Practice Address - Street 2:STE 206
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3126
Practice Address - Country:US
Practice Address - Phone:856-234-6045
Practice Address - Fax:856-234-0498
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04503100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60089867OtherHORIZON NJ HEALTH
NJ3451402Medicaid
NJ1443064OtherCIGNA
NJ100080946302OtherAMERICHOICE
NJ0070964000OtherAMERIHEALTH
NJ8386519OtherAETNA
NJ1443064OtherCIGNA
NJ3451402Medicaid
NJ011914R63Medicare PIN