Healthcare Provider Details

I. General information

NPI: 1982634341
Provider Name (Legal Business Name): PAUL J. MACKOUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE STE 414
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

PO BOX 37230
BALTIMORE MD
21297-3230
US

V. Phone/Fax

Practice location:
  • Phone: 410-990-4480
  • Fax: 410-990-4484
Mailing address:
  • Phone: 410-990-4480
  • Fax: 410-990-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberD0047612
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: