Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 25MA09142500 | NJ |
Y | 208000000X | Pediatrician | 25MA09142500 | NJ |
NPI | 1669616595 |
---|---|
Provider Name | Dr. Alexander Paul Materna |
First Address | Marlton, NJ 08053-3426 |
Second Address | Hamilton, NJ 08690-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 03/01/2022 |