Provider Demographics
NPI:1306889423
Name:MACKLE, EDWARD J (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:MACKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:STE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-337-4168
Practice Address - Fax:717-337-4318
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD052341L207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50067114OtherCAPITAL BLUE CROSS GH
PAP00010335OtherRAILROAD MEDICARE GH
PA34349OtherGEISINGER-GH
PA141059OtherUNISON GH
PA0710598000OtherAMERIHEALTH 65 PA-GH
PA1531317OtherGATEWAY GH
PA20021398OtherAMERIHEALTH MERCY-GH
PA766549OtherHIGHMARK GH
PAP00010335OtherRAILROAD MEDICARE GH
PA766549OtherHIGHMARK GH