Provider Demographics
NPI:1396771283
Name:TAKLA, MADGY
Entity type:Individual
Prefix:
First Name:MADGY
Middle Name:
Last Name:TAKLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE SW200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-356-4710
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER ANESTHESIA ASSOCIATES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:856-968-8326
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06264500207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8783501Medicaid
NJ010007776OtherAMERICHOICE
NJ1121097OtherAETNA
NJ2075003000OtherAMERIHEALTH/KEYSTONE/IBC/PABS
NJP3722605OtherOXFORD
NJ1121106OtherAETNA
NJ2735366OtherCIGNA
NJ2816920OtherUNITED HEATHCARE
NJ1384269OtherAMERIHEALTH PPO/PA BS
NJ60022562OtherHORIZON NJ HEALTH
NJ2735366OtherCIGNA
NJ1384269OtherAMERIHEALTH PPO/PA BS