1639207780 NPI number — MRS. MANJIT KAUR MACKER MD

Table of content: MRS. MANJIT KAUR MACKER MD (NPI 1639207780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639207780 NPI number — MRS. MANJIT KAUR MACKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKER
Provider First Name:
MANJIT
Provider Middle Name:
KAUR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAUR
Provider Other First Name:
MANJIT
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639207780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 LYNN MANOR DRIVE
Provider Second Line Business Mailing Address:
317
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-4427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-610-9323
Provider Business Mailing Address Fax Number:
301-372-1835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9400 SURRATTS RD
Provider Second Line Business Practice Location Address:
RICA SOUTHERN MARYLAND
Provider Business Practice Location Address City Name:
CHELTENHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20623-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-372-1832
Provider Business Practice Location Address Fax Number:
301-372-1835
Provider Enumeration Date:
03/01/2007

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: 208000000X , with the licence number:  D0018530 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B2211 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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