Healthcare Provider Details

I. General information

NPI: 1386652154
Provider Name (Legal Business Name): SUE A. MAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

100 E PENN SQ 9TH FLOOR NORTH TOWER
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 609-345-4000
  • Fax: 609-572-8523
Mailing address:
  • Phone: 267-425-9232
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD068616L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07097700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: