Main Street Family Medicine, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MB42970 Issued in NJ

Legal business name

MAIN STREET FAMILY MEDICINE, PA

Practice address

111 Vine St
Hammonton, NJ 08037-1447

Phone

(609) 561-2518

NPI assigned

Dec 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Walter D Crane, D.O.

Title

Physician

Phone

(609) 561-2518

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1467510008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 VINE ST",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080371447",
            "telephone_number": "609-561-2518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 VINE ST",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080371447",
            "telephone_number": "609-561-2518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "CRANE",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "609-561-2518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MB42970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3411001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Joyce Loughlin-Pherribo, D.O.
• Angelo A Luzzi, DPM
• Okechukwu Anslem Madu, APN
• Magic Cure LLC
• Jamal Mahmud, M.D.
• Jillian Nicole Maisch, OT
• Tiffani Major, DIPLOMA
• Robert Eugene Mann, APN
• Maple Leaf Physical Therapy PC
• Michele Marciano, LCSW, LCADC

• Family Medicine Physician in Hammonton, NJ
• Providers in Hammonton, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.