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NPI Code Detail

MEDICARE: DR. MATTHEW D MACK MD

MEDICARE: DR. MATTHEW D 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
1208D00000XGeneral Practice Physician252075NY

General Provider Information

NPI Number : 1770506958
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW D MACK MD
Provider Business Mailing Address
First Line : 180 MOUNT VERNON AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-2344
Country : US
Telephone Number : 585-747-3297
Fax Number :
Provider Business Practice Location Address
First Line : 340 ARNETT BLVD
Second Line :
City : ROCHESTER
State : NY
Zip : 14619-1147
Country : US
Telephone Number : 585-235-2250
Fax Number : 585-235-0011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 04/15/2025

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