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General NPI Number Information
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NPI Number | 1245887835
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Entity Type | Individual
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Provider Name | HERSHEL MACK PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 885 SCHUMANN DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-6878
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Country | US
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Telephone | 757-708-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 MONARCH WAY STE 500
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City | NORFOLK
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State | VA
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Zip | 23508-2563
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Country | US
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Telephone | 757-477-6812
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126001007
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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