Carol Jean Mack, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA30161 Issued in DC

Practice address

1850 M St NW
Suite 450
Washington, DC 20036-5803

Phone

(202) 293-1000

NPI assigned

Nov 30, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• James a Simon, MD, PC

  • Gynecology Physician
  • Washington, DC
  • NPI 1922169408

  Physician Assistant

  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235207366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 NORRIS CT SW",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201754361",
            "telephone_number": "703-669-9343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 M ST NW",
            "address_2": "SUITE 450",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200365803",
            "telephone_number": "202-293-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "CAROL",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA30161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA30161",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra Maciuba, RN
• Fanforda Olivia Macjohnson
• Aaron Alexander Mack, MD, MSC.
• Aleshia Mack
• Briana Nicole Mack, LGPC
• Chakeena Renee Mack
• Charnetta Mack, HHA
• Daijah Mack
• Destiny L Mack
• Donesha Mack

• Physician Assistant in Washington, DC
• Providers in Washington, DC by specialty
• Physician Assistant in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.