Healthcare Provider Details

I. General information

NPI: 1437476777
Provider Name (Legal Business Name): THE CENTER FOR INNOVATIVE GYN CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 TOWER OAKS BLVD STE 200
ROCKVILLE MD
20852-4253
US

IV. Provider business mailing address

3206 TOWER OAKS BLVD STE 200
ROCKVILLE MD
20852-4253
US

V. Phone/Fax

Practice location:
  • Phone: 301-652-4800
  • Fax: 301-664-6475
Mailing address:
  • Phone: 301-652-4800
  • Fax: 301-664-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL J MACKOUL
Title or Position: OWNER
Credential: MD
Phone: 301-404-6490