Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 52132 | CT |
N | 207PP0204X | Pediatric Emergency Physician | MD13276 | RI |
N | 208000000X | Pediatrician | 247472 | NY |
Y | 208000000X | Pediatrician | MD13276 | RI |
NPI | 1275790958 |
---|---|
Provider Name | Dr. Bonnie Suzanne Mackenzie |
First Address | New London, CT 06320-4700 |
Second Address | New London, CT 06320-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 09/07/2013 |