=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760425078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES EDWARD MACKLIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 MCNAUGHTEN ROAD SUITE 130
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-577-8322
-----------------------------------------------------
Fax | 614-577-8302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3555 OLENTANGY RIVER RD SUITE 3070
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-566-2942
-----------------------------------------------------
Fax | 614-566-6886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 35041210
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 35041210
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------