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General NPI Number Information
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NPI Number | 1629724588
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Entity Type | Individual
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Provider Name | MACKENZIE SUZANNE QUINN
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Gender | Female
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 11110 MEDICAL CAMPUS RD
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City | HAGERSTOWN
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State | MD
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Zip | 21742-6700
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Country | US
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Telephone | 301-714-4350
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Fax |
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Provider Business Mailing Address
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Address Line | 2476 KELLER RD
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City | SAINT THOMAS
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State | PA
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Zip | 17252-9785
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Country | US
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Telephone | 717-830-3349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207Q00000X
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C08871
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License Number State | MD
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