Provider Demographics
NPI:1306931092
Name:IAVICOLI, MICHELLE A (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:IAVICOLI
Suffix:
Gender:F
Credentials:MD
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 # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1103 KINGS HWY N
Practice Address - Street 2:SUITE 201
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1983
Practice Address - Country:US
Practice Address - Phone:856-321-1800
Practice Address - Fax:856-321-0133
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58121207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1163594OtherHORIZON NJ HEALTH
NJ2067761OtherUNITED HEALTHCARE
NJ010003803OtherAMERICHOICE
NJ160055209OtherRR MEDICARE
NJ24630OtherUNIVERSITY HEALTH PLAN
NJ3K6126OtherHEALTHNET
NJ783367OtherAMERIHEALTH PPO/PA BS
NJ783367OtherPA BS HIGHMARK
NJ1078883OtherHORIZON NJ HEALTH
NJ2207020OtherAETNA
NJ2542331OtherCIGNA
NJ7615001Medicaid
NJJP131OtherOXFORD
NJ0809776000OtherAMERIHEALTH/KEYSTONE/IBC
NJ2051479OtherAETNA
NJJP131OtherOXFORD
NJ2207020OtherAETNA