Provider Demographics
NPI:1699108951
Name:MAC PHYSICIANS LLC
Entity type:Organization
Organization Name:MAC PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHALLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-235-8808
Mailing Address - Street 1:1205 KINTERRA CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6976
Mailing Address - Country:US
Mailing Address - Phone:302-235-8808
Mailing Address - Fax:302-351-8769
Practice Address - Street 1:5936 LIMESTONE RD STE 301B
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8932
Practice Address - Country:US
Practice Address - Phone:302-235-8808
Practice Address - Fax:302-235-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004737174400000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012007330059Medicaid