Healthcare Provider Details

I. General information

NPI: 1972574523
Provider Name (Legal Business Name): SUZANNE FULLER MACKEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD SUITE 505
VOORHEES NJ
08043-4501
US

IV. Provider business mailing address

2301 E EVESHAM RD STE 111
VOORHEES NJ
08043-4504
US

V. Phone/Fax

Practice location:
  • Phone: 856-861-6320
  • Fax: 856-888-2640
Mailing address:
  • Phone: 856-861-6320
  • Fax: 856-888-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number25MA07049100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA07049100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number25MA07049100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: