Provider Demographics
NPI:1366732620
Name:MACKEM, SUSAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:MACKEM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1050 BOYLES ST
Mailing Address - Street 2:MAIL STOP 5, BLDG 539, ROOM 121A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9242
Mailing Address - Country:US
Mailing Address - Phone:301-228-4200
Mailing Address - Fax:301-846-7117
Practice Address - Street 1:1050 BOYLES ST
Practice Address - Street 2:MAIL STOP 5, BLDG 539, ROOM 121A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9242
Practice Address - Country:US
Practice Address - Phone:301-228-4200
Practice Address - Fax:301-846-7117
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
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Provider Licenses
StateLicense IDTaxonomies
MDD0037718207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology