Provider Demographics
NPI:1366097172
Name:MULLICA HILL ANESTHESIA
Entity type:Organization
Organization Name:MULLICA HILL ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-841-3049
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1029
Mailing Address - Country:US
Mailing Address - Phone:609-841-3049
Mailing Address - Fax:
Practice Address - Street 1:199 MULLICA HILL RD BLDG B
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2655
Practice Address - Country:US
Practice Address - Phone:856-362-8898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty