Full Name | |
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Speciality | Internal Medicine |
Location | 851 Main St, Shiloh, New Jersey |
Authorized Official Name and Position | Robert W Dickson (SOLE OWNER) |
Authorized Official Contact | 8564551464 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 110 Shiloh NJ 08353-0110 Ph: (856) 455-1464 | 851 Main St Shiloh NJ 08353-8505 Ph: (856) 455-1464 |
NPI Number | 1003904269 |
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Provider Enumeration Date | 10/11/2006 |
Last Update Date | 07/16/2013 |
Medicare PECOS PAC ID | 7113972688 |
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Medicare Enrollment ID | O20050317000335 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003904269 | NPI | - | NPPES |
2673304 | Medicaid | NJ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | MA53365 (New Jersey) | Primary |
Provider Name | Robert W Dickson |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1851314017 PECOS PAC ID: 4688619224 Enrollment ID: I20050623000432 |