Provider Demographics
NPI:1396297321
Name:ADVANCED MEDICAL CARE CENTER
Entity type:Organization
Organization Name:ADVANCED MEDICAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWADROUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-581-9711
Mailing Address - Street 1:901 ROUTE 73 N
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 73 N
Practice Address - Street 2:SUITE C
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1226
Practice Address - Country:US
Practice Address - Phone:856-581-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07842400332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site