Provider Demographics
NPI:1366421661
Name:SCUDERI, STEVEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:SCUDERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 ROUTE 73 N
Mailing Address - Street 2:40 LAKE CENTER DRIVE SUITE 201A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3425
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0346
Practice Address - Street 1:103 OLD MARLTON PIKE
Practice Address - Street 2:SUITE 111
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:609-953-7111
Practice Address - Fax:856-953-1544
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04785100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0641308Medicaid
NJ524515YBAWMedicare PIN
NJE51887Medicare UPIN
NJ0641308Medicaid