MEDICARE: DR. EMILI RACHELE MACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2005-01260	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2005-01260	OTHER	NC	STATE MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184618019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILI RACHELE MACK MD

Provider Business Mailing Address
First Line	:	3721 LYNN RD STE 104
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-3855
Country	:	US
Telephone Number	:	919-825-3600
Fax Number	:	984-200-6001

Provider Business Practice Location Address
First Line	:	3721 LYNN RD STE 104
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-3855
Country	:	US
Telephone Number	:	919-825-3600
Fax Number	:	984-200-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	03/07/2023

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