Provider Demographics
NPI:1124149539
Name:MACKLER, STUART FRED (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:FRED
Last Name:MACKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 GULL POINT RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23354-0099
Mailing Address - Country:US
Mailing Address - Phone:775-744-2615
Mailing Address - Fax:
Practice Address - Street 1:7336 GULL POINT RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23354-0099
Practice Address - Country:US
Practice Address - Phone:775-744-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist