MEDICARE: ANGELA MACKAY PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R224907	MD

General Provider Information

NPI Number	:	1720655053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MACKAY PMHNP-BC

Provider Business Mailing Address
First Line	:	8000 JUMPERS HOLE RD STE 217
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-1046
Country	:	US
Telephone Number	:	240-883-4025
Fax Number	:	410-415-3722

Provider Business Practice Location Address
First Line	:	8000 JUMPERS HOLE RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-1036
Country	:	US
Telephone Number	:	240-883-4025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	05/03/2023

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