Provider Demographics
NPI:1548519457
Name:UNDERWOOD-MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:UNDERWOOD-MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC.VP/ COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-845-0100
Mailing Address - Street 1:1120 DELSEA DR N
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028
Mailing Address - Country:US
Mailing Address - Phone:856-686-5480
Mailing Address - Fax:856-686-5455
Practice Address - Street 1:100 LEXINGTON RD
Practice Address - Street 2:BLDG 1
Practice Address - City:WOOLWICH TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1276
Practice Address - Country:US
Practice Address - Phone:856-467-7360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNDERWOOD-MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty