Provider Demographics
NPI:1083983209
Name:HADDONFIELD DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:HADDONFIELD DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:SUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-795-1341
Mailing Address - Street 1:24 KINGS HWY W
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2111
Mailing Address - Country:US
Mailing Address - Phone:856-795-1341
Mailing Address - Fax:856-795-5034
Practice Address - Street 1:24 KINGS HWY W
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2111
Practice Address - Country:US
Practice Address - Phone:856-795-1341
Practice Address - Fax:856-795-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08338300207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty