Provider Demographics
NPI:1275625410
Name:SUAREZ, KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:817 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1539
Practice Address - Country:US
Practice Address - Phone:856-583-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065921L207V00000X
NJMA078875207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088617Medicaid
NJ2623072000OtherAMERIHEALTH/KEYSTONE/IBC
NJAMERIHEALTH PPO/PABSOther1785772
NJ42300OtherUNIVERISTY HEALTH PLAN
NJ3970934OtherAETNA
NJ1294758OtherCIGNA
NJ60021901OtherHORIZON NJ HEALTH
NJ1812647OtherUNITED HEALTHCARE
NJ3K6167OtherHEALTHNET
NJP3700979OtherOXFORD
NJ010007623OtherAMERICHOICE
NJ3970939OtherAETNA
NJP00478707OtherRR MEDICARE
NJ42300OtherUNIVERISTY HEALTH PLAN
NJ0088617Medicaid
NJ099087 BKRMedicare PIN