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NPI Code Detail

MEDICARE: DR. MACKENZIE ALEECE MADY D.O.

MEDICARE: DR. MACKENZIE ALEECE MADY D.O.
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
1207Q00000XFamily Medicine PhysicianOS015038PA

General Provider Information

NPI Number : 1760641328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MACKENZIE ALEECE MADY D.O.
Provider Business Mailing Address
First Line : 109 STATE ST.
Second Line : 5TH FL
City : BOSTON
State : MA
Zip : 02109-2906
Country : US
Telephone Number : 617-505-1520
Fax Number : 617-928-8401
Provider Business Practice Location Address
First Line : 100 SOUTH JUNIPER
Second Line : 3RD FLOOR #8528
City : PHILADELPHIA
State : PA
Zip : 19107-1316
Country : US
Telephone Number : 617-505-1520
Fax Number : 617-928-8401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2008
Last Update Date : 03/27/2026

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