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General NPI Number Information
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NPI Number | 1245619105
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Entity Type | Individual
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Provider Name | ANNA MACKIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 1819 ELECTRIC RD STE 1B
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City | ROANOKE
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State | VA
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Zip | 24018-1605
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Country | US
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Telephone | 540-855-5120
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Fax | 540-342-4373
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Provider Business Mailing Address
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Address Line | 1819 ELECTRIC RD STE 1B
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City | ROANOKE
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State | VA
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Zip | 24018-1605
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Country | US
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Telephone | 540-855-5120
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Fax | 540-342-4373
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | TL.0006375
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 036.149405
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 0101271654
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License Number State | VA
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