MEDICARE: DR. MAUREEN SUZANNE CLINCH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00284900	NJ
2	213ES0103X	Foot & Ankle Surgery Podiatrist	SC005610	PA

General Provider Information

NPI Number	:	1467416339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUREEN SUZANNE CLINCH DPM

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	609-267-9400
Fax Number	:	856-234-3921

Provider Business Practice Location Address
First Line	:	300 W ROUTE 38 STE A
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3424
Country	:	US
Telephone Number	:	609-267-9400
Fax Number	:	856-234-3921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/01/2025

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