Provider Demographics
NPI:1366575516
Name:SUCKFUELL, MARION EVELYN (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:EVELYN
Last Name:SUCKFUELL
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 1:1383 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4885
Mailing Address - Country:US
Mailing Address - Phone:813-681-5714
Mailing Address - Fax:813-689-9557
Practice Address - Street 1:1383 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4885
Practice Address - Country:US
Practice Address - Phone:813-681-5714
Practice Address - Fax:813-689-9557
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME583462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE61792Medicare UPIN