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General NPI Number Information
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NPI Number | 1760574552
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Entity Type | Individual
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Provider Name | WILLIAM G. MACKENZIE MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 1600 ROCKLAND RD NEMOURS DUPONT PEDIATRICS
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City | WILMINGTON
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State | DE
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Zip | 19803-3607
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Country | US
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Telephone | 302-651-4000
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Fax | 302-651-4945
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Provider Business Mailing Address
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Address Line | PO BOX 191 PROVIDER ENROLLMENT DEPT
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City | ROCKLAND
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State | DE
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Zip | 19732-0191
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Country | US
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Telephone | 302-651-6212
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Fax | 302-651-4945
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C10004167
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | C10004167
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | MD054069L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | ME130481
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License Number State | FL
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