MEDICARE: HARRY A. ACKLEY 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	2080N0001X	Neonatal-Perinatal Medicine Physician	G14161	CA

General Provider Information

NPI Number	:	1588697478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY A. ACKLEY M.D.

Provider Business Mailing Address
First Line	:	212 CONCORD DR
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-2942
Country	:	US
Telephone Number	:	650-325-5054
Fax Number	:	650-325-5254

Provider Business Practice Location Address
First Line	:	212 CONCORD DR
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-2942
Country	:	US
Telephone Number	:	650-325-5054
Fax Number	:	650-325-5254

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/17/2008

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