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NPI Code Detail

MEDICARE: PAUL MACKOUL MD

MEDICARE: PAUL MACKOUL MD
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
1207VX0201XGynecologic Oncology PhysicianD0047612MD

General Provider Information

NPI Number : 1396751921
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUL MACKOUL MD
Provider Business Mailing Address
First Line : PO BOX 37230
Second Line :
City : BALTIMORE
State : MD
Zip : 21297-3230
Country : US
Telephone Number : 301-652-4800
Fax Number : 301-664-6475
Provider Business Practice Location Address
First Line : 129 LUBRANO DRIVE
Second Line : SUITE 101
City : ANNAPOLIS
State : MD
Zip : 21401-7566
Country : US
Telephone Number : 410-897-0501
Fax Number : 410-897-0504
Authorized Official
Title or Position : BILLING & COLLECTION MANAGER
Name : LAVINA JACKS
Credential :
Telephone Number : 301-652-4800
Provider Enumeration Date : 08/01/2006
Last Update Date : 09/17/2012

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