Provider Demographics
NPI:1730391301
Name:PREVITY, MARY ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:PREVITY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:312 W REDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2528
Mailing Address - Country:US
Mailing Address - Phone:856-354-8022
Mailing Address - Fax:856-354-1843
Practice Address - Street 1:7740 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-5528
Practice Address - Country:US
Practice Address - Phone:856-663-3300
Practice Address - Fax:856-663-2224
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB042206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine