Provider Demographics
NPI:1962692715
Name:OLSON, AUBREY (DO)
Entity type:Individual
Prefix:DR
First Name:AUBREY
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:MARISA
Other - Last Name:TROUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD STE 2100-A
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-7020
Mailing Address - Fax:856-566-6188
Practice Address - Street 1:42 E LAUREL RD STE 2100-A
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7020
Practice Address - Fax:856-566-6188
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08646200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0239020Medicaid
NJ190410ASDMedicare PIN