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General NPI Number Information
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NPI Number | 1396751921
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Entity Type | Organization
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Legal Business Name | PAUL MACKOUL MD
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 129 LUBRANO DRIVE SUITE 101
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7566
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Country | US
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Telephone | 410-897-0501
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Fax | 410-897-0504
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Provider Business Mailing Address
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Address Line | PO BOX 37230
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City | BALTIMORE
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State | MD
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Zip | 21297-3230
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Country | US
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Telephone | 301-652-4800
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Fax | 301-664-6475
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Authorized Official
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Title or Position | BILLING & COLLECTION MANAGER
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Name | LAVINA JACKS
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Credential |
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Telephone | 301-652-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | D0047612
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License Number State | MD
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