Provider Demographics
NPI:1538198346
Name:STAILEY-SIMS, MARY K (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:STAILEY-SIMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:435 HURFFVILLE CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2453
Practice Address - Country:US
Practice Address - Phone:856-582-2816
Practice Address - Fax:856-582-2712
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB74225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8979006Medicaid
073421SK3Medicare PIN
NJ8979006Medicaid
H94499Medicare UPIN
077356Medicare Oscar/Certification