Provider Demographics
NPI:1578026944
Name:PERDUE, MAKENZIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LYNN
Last Name:PERDUE
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 1:4165 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3811
Mailing Address - Country:US
Mailing Address - Phone:484-547-7217
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST FRNT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4420
Practice Address - Country:US
Practice Address - Phone:215-955-1085
Practice Address - Fax:215-955-5041
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481751207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology