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NPI Code Detail

MEDICARE: KARIN F MACK M.D.

MEDICARE: KARIN F MACK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician042-0009090VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1126-1087OTHERVTBLUE CROSS
2970368OTHERMVP
32018556OTHERCIGNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
510010392OTHERCDPHP

General Provider Information

NPI Number : 1114946035
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARIN F MACK M.D.
Provider Business Mailing Address
First Line : PO BOX 588
Second Line :
City : BENNINGTON
State : VT
Zip : 05201-0588
Country : US
Telephone Number : 802-442-5491
Fax Number : 802-442-4910
Provider Business Practice Location Address
First Line : 100 LEDGEHILL RD
Second Line :
City : BENNINGTON
State : VT
Zip : 05201-2273
Country : US
Telephone Number : 802-442-5491
Fax Number : 802-442-4910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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Directions to “ KARIN F MACK M.D.” Practice Location

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