Provider Demographics
NPI:1467924068
Name:B SUZANNE MCKELL DO INC
Entity Type:Organization
Organization Name:B SUZANNE MCKELL DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:MCKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:650-276-0170
Mailing Address - Street 1:248 MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-7120
Mailing Address - Country:US
Mailing Address - Phone:650-276-0170
Mailing Address - Fax:650-440-4887
Practice Address - Street 1:248 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7120
Practice Address - Country:US
Practice Address - Phone:650-276-0170
Practice Address - Fax:650-440-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty