Provider Demographics
NPI:1396751921
Name:PAUL MACKOUL MD
Entity type:Organization
Organization Name:PAUL MACKOUL MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING & COLLECTION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-652-4800
Mailing Address - Street 1:PO BOX 37230
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3230
Mailing Address - Country:US
Mailing Address - Phone:301-652-4800
Mailing Address - Fax:301-664-6475
Practice Address - Street 1:129 LUBRANO DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7566
Practice Address - Country:US
Practice Address - Phone:410-897-0501
Practice Address - Fax:410-897-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047612207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD281PMedicare PIN