MEDICARE: DR. ANNE C MACK M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	C10004256	DE
2	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	C10004256	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250004651	OTHER	DE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	510329923	OTHER	DE	UNITED HEALTH CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0000542301	OTHER	DE	DE PHYSICIANS CARE
5	0691099000	OTHER	DE	AMERIHEALTH-HMO
6	1131445	OTHER	DE	CIGNA
7	386606954	OTHER	DE	BC/BS
8	P2727901	OTHER	DE	OXFORD HEALTH PLAN
9	5749069	OTHER	DE	AMERIHEALTH PPO
10	2008066	OTHER	DE	AETNA-HMO
11	293736	OTHER	DE	MIAMSI/OPTIMUM CHOICE
12	4390070	OTHER	DE	AETNA-PPO
13	46211	OTHER	DE	COVENTRY
14	510329923	OTHER	DE	TRICARE STANDARD

General Provider Information

NPI Number	:	1285744862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE C MACK M.D.

Provider Business Mailing Address
First Line	:	700 W LEA BLVD
Second Line	:	SUITE 102
City	:	WILMINGTON
State	:	DE
Zip	:	19802-2500
Country	:	US
Telephone Number	:	302-764-0271
Fax Number	:	302-762-4076

Provider Business Practice Location Address
First Line	:	2006 FOULK RD
Second Line	:	SUITE B
City	:	WILMINGTON
State	:	DE
Zip	:	19810-3644
Country	:	US
Telephone Number	:	302-529-8783
Fax Number	:	302-529-7470

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/01/2016

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