Provider Demographics
NPI:1932250800
Name:JAMES V. MACKELL, JR. M.D.
Entity type:Organization
Organization Name:JAMES V. MACKELL, JR. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:MACKELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-335-4230
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-6628
Mailing Address - Country:US
Mailing Address - Phone:215-830-9991
Mailing Address - Fax:
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-4230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008475570002Medicaid
PA0008475570002Medicaid