Provider Demographics
NPI:1144263500
Name:COX, MARY JUDE (MD)
Entity type:Individual
Prefix:
First Name:MARY JUDE
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 WHITE HORSE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2106
Mailing Address - Country:US
Mailing Address - Phone:856-784-3366
Mailing Address - Fax:856-784-4388
Practice Address - Street 1:1140 WHITE HORSE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2106
Practice Address - Country:US
Practice Address - Phone:856-784-3366
Practice Address - Fax:856-784-4388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07415200207W00000X
PAMD074038L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH39304Medicare UPIN
NJ064963Medicare ID - Type Unspecified