Provider Demographics
NPI:1982707931
Name:MACKNIN, CAROL HYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:HYMAN
Last Name:MACKNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23230 CHAGRIN BLVD
Mailing Address - Street 2:#845
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5446
Mailing Address - Country:US
Mailing Address - Phone:216-595-9260
Mailing Address - Fax:216-763-9279
Practice Address - Street 1:23230 CHAGRIN BLVD
Practice Address - Street 2:#845
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5446
Practice Address - Country:US
Practice Address - Phone:216-595-9260
Practice Address - Fax:216-763-9279
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350590982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0791022Medicaid
OHMA0668761Medicare ID - Type Unspecified
OH0791022Medicaid