Provider Demographics
NPI:1760641328
Name:MADY, MACKENZIE ALEECE (DO)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:ALEECE
Last Name:MADY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:502 S 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:PA
Practice Address - Zip Code:17970-1377
Practice Address - Country:US
Practice Address - Phone:570-621-4364
Practice Address - Fax:570-621-4641
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT011963207Q00000X
PAOS015038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine