Provider Demographics
NPI:1962618686
Name:MACK, MARGARET M (PHD, MA, APRN BC)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:M
Last Name:MACK
Suffix:
Gender:F
Credentials:PHD, MA, APRN BC
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 GUYENNE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1414
Mailing Address - Country:US
Mailing Address - Phone:302-656-4595
Mailing Address - Fax:
Practice Address - Street 1:10 GUYENNE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-1414
Practice Address - Country:US
Practice Address - Phone:302-530-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000123364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE011570V39Medicare PIN