Provider Demographics
NPI:1508806647
Name:BOOKER, FELICIA M (MD)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:M
Other - Last Name:CONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N BLDG 10, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:609-625-8585
Mailing Address - Fax:609-625-3415
Practice Address - Street 1:5401 HARDING HWY STE 6
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2243
Practice Address - Country:US
Practice Address - Phone:609-625-8585
Practice Address - Fax:609-625-3415
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068653L208000000X
NJ25MA06550600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG77189Medicare UPIN
PA038226Medicare ID - Type Unspecified