Provider Demographics
NPI:1174130835
Name:DMM MEDICAL CONSULTING GROUP LLC
Entity type:Organization
Organization Name:DMM MEDICAL CONSULTING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZYCK
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-847-0538
Mailing Address - Street 1:212 N ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2102
Mailing Address - Country:US
Mailing Address - Phone:609-847-0538
Mailing Address - Fax:609-543-2433
Practice Address - Street 1:4551 ROUTE 42 STE 3
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1751
Practice Address - Country:US
Practice Address - Phone:609-337-2211
Practice Address - Fax:609-543-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty