Provider Demographics
NPI:1841783438
Name:MCDIVITT, DYLAN JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JAMES
Last Name:MCDIVITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:786 CARTERET CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3205
Mailing Address - Country:US
Mailing Address - Phone:856-641-8000
Mailing Address - Fax:
Practice Address - Street 1:125 EAST AVE STE C
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1351
Practice Address - Country:US
Practice Address - Phone:856-769-2800
Practice Address - Fax:856-769-4256
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB10990100207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine