1285744862 NPI number — DR. ANNE C MACK M.D.

Table of content: DR. ANNE C MACK M.D. (NPI 1285744862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285744862 NPI number — DR. ANNE C MACK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACK
Provider First Name:
ANNE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONNER
Provider Other First Name:
ANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285744862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 W LEA BLVD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19802-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-764-0271
Provider Business Mailing Address Fax Number:
302-762-4076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 FOULK RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-529-8783
Provider Business Practice Location Address Fax Number:
302-529-7470
Provider Enumeration Date:
08/30/2006

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: 208100000X , with the licence number:  C10004256 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P0301X , with the licence number: C10004256 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 250004651 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000542301 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000542301 . This is a "DE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0691099000 . This is a "AMERIHEALTH-HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1131445 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 386606954 . This is a "BC/BS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P2727901 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 5749069 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2008066 . This is a "AETNA-HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 293736 . This is a "MIAMSI/OPTIMUM CHOICE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 4390070 . This is a "AETNA-PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 46211 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "TRICARE STANDARD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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