Provider Demographics
NPI:1467416339
Name:CLINCH, MAUREEN SUZANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:SUZANNE
Last Name:CLINCH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8001 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-332-5300
Mailing Address - Fax:215-332-5228
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-332-5300
Practice Address - Fax:215-332-5228
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005610213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097794MNWMedicare PIN
PAV07591Medicare UPIN
PA096558MNAMedicare PIN
NJ097794MNCMedicare PIN