Provider Demographics
NPI:1912906561
Name:TYRRELL, ROBERT CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:TYRRELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2314
Mailing Address - Country:US
Mailing Address - Phone:856-869-0202
Mailing Address - Fax:856-869-8159
Practice Address - Street 1:2250 CHAPEL AVE W STE 130
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2051
Practice Address - Country:US
Practice Address - Phone:856-663-3733
Practice Address - Fax:856-663-3660
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00180000213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0114943000OtherAMERIHEALTH
NJ441295OtherUNITED HEALTHCARE
NJ0928309OtherAETNA
NJE34136OtherAMERIHEALTH ADMINITRATORS
NJ1189506Medicaid
NJ2232722520OtherHORIZON BLUE SHIELD NJ
NJ000534136OtherHIGHMARK BLUE SHIELD PA
NJ534136Medicare ID - Type Unspecified
NJ1189506Medicaid