Provider Demographics
NPI:1811906878
Name:MAMA, SAIFUDDIN T (MD)
Entity type:Individual
Prefix:
First Name:SAIFUDDIN
Middle Name:T
Last Name:MAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLAZA
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:127 N CHURCH ROAD
Practice Address - Street 2:SUITE 200 COOPER FACULTY OBGYN
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-5691
Practice Address - Fax:856-983-5763
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-060937-L208000000X
NJMA0788960207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0118818Medicaid
PA0016567740011Medicaid
NJ0118818Medicaid
NJ105629BKRMedicare PIN
PA0016567740011Medicaid