MEDICARE: MACK PEDIATRICS PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34D2157235	OTHER	NC	CLIA LABORATORY PROGRAM

General Provider Information

NPI Number	:	1881169514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACK PEDIATRICS PLLC

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	:	PHYSICIAN, OWNER
Name	:	DR. EMILI RACHELE MACK
Credential	:	MD
Telephone Number	:	919-825-3600

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	04/30/2019

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Directions to “MACK PEDIATRICS PLLC ” Practice Location

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