Provider Demographics
NPI:1174184097
Name:MAMMEN, ASHBY ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:ASHBY
Middle Name:ABRAHAM
Last Name:MAMMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-7118
Mailing Address - Fax:856-355-7116
Practice Address - Street 1:1605 E EVESHAM RD STE 100B
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1437
Practice Address - Country:US
Practice Address - Phone:856-355-7118
Practice Address - Fax:856-355-7116
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT2177862084P0800X
NJ25MA122656002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry