Provider Demographics
NPI:1487620407
Name:CULLEN, EUGENE A (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:CULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:565-048-0298
Practice Address - Street 1:210 ROUTE 94
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2764
Practice Address - Country:US
Practice Address - Phone:908-362-9285
Practice Address - Fax:908-362-7756
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7575602Medicaid
NJ008982DSVMedicare ID - Type Unspecified
NJ7575602Medicaid