Provider Demographics
NPI:1649273038
Name:VERNON, PAUL L (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:VERNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2026 BRIGGS RD
Mailing Address - Street 2:STE B
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4602
Mailing Address - Country:US
Mailing Address - Phone:856-235-1211
Mailing Address - Fax:856-231-1149
Practice Address - Street 1:2026 BRIGGS RD
Practice Address - Street 2:STE B
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4602
Practice Address - Country:US
Practice Address - Phone:856-235-1211
Practice Address - Fax:856-231-1149
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03903900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0429309Medicaid
NJ184062Medicare ID - Type Unspecified
NJC53775Medicare UPIN