1639362023 NPI number — CYNTHIA A MACKLIN P.A.

Table of content: CYNTHIA A MACKLIN P.A. (NPI 1639362023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639362023 NPI number — CYNTHIA A MACKLIN P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKLIN
Provider First Name:
CYNTHIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639362023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2979 SQUALICUM PKWY
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-733-7670
Provider Business Mailing Address Fax Number:
360-647-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2979 SQUALICUM PKWY
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-733-7670
Provider Business Practice Location Address Fax Number:
360-647-1901
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA60221857 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GAB23289 . This is a "PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8903574 . This is a "PTA#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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