Provider Demographics
NPI:1972574523
Name:MACKEY, SUZANNE FULLER (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:FULLER
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD STE 111
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4504
Mailing Address - Country:US
Mailing Address - Phone:856-861-6320
Mailing Address - Fax:856-888-2640
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 505
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-861-6320
Practice Address - Fax:856-888-2640
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07049100207VB0002X, 207VG0400X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH12715Medicare UPIN
NJ036693N5TMedicare PIN