Provider Demographics
NPI:1285744862
Name:MACK, ANNE C (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:C
Last Name:MACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 W LEA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2500
Mailing Address - Country:US
Mailing Address - Phone:302-764-0271
Mailing Address - Fax:302-762-4076
Practice Address - Street 1:2006 FOULK RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3644
Practice Address - Country:US
Practice Address - Phone:302-529-8783
Practice Address - Fax:302-529-7470
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004256208100000X, 2081P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250004651OtherRAILROAD MEDICARE
DE510329923OtherUNITED HEALTH CARE
DE0000542301Medicaid
DE0000542301OtherDE PHYSICIANS CARE
DE0691099000OtherAMERIHEALTH-HMO
DE1131445OtherCIGNA
DE386606954OtherBC/BS
DEP2727901OtherOXFORD HEALTH PLAN
DE5749069OtherAMERIHEALTH PPO
DE2008066OtherAETNA-HMO
DE293736OtherMIAMSI/OPTIMUM CHOICE
DE4390070OtherAETNA-PPO
DE46211OtherCOVENTRY
DE510329923OtherTRICARE STANDARD
DEF26926Medicare UPIN
DE0000542301Medicaid