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General NPI Number Information
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NPI Number | 1184100158
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Entity Type | Individual
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Provider Name | LISA MAC PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 9000 ROCKVILLE PIKE BLDG 10
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 302-228-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 5316 SEAHORSE PL
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City | WALDORF
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State | MD
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Zip | 20603-4375
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Country | US
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Telephone | 313-717-6373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0006846
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License Number State | MD
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