Vicki Lynn Mack, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD067040L Issued in PA

Practice address

125 N Enola Dr
Suite 101
Enola, PA 17025-2500

Phone

(717) 732-7171

Fax

(717) 732-8872

NPI assigned

Jul 24, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pennsboro Pediatrics, LLC

  • Pediatrics Physician
  • Enola, PA
  • NPI 1760588552
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730101254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N ENOLA DR",
            "address_2": "SUITE 101",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170252500",
            "telephone_number": "717-732-7171",
            "fax_number": "717-732-8872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N ENOLA DR",
            "address_2": "SUITE 101",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170252500",
            "telephone_number": "717-732-7171",
            "fax_number": "717-732-8872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "VICKI",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD067040L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017468620001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica L Logan, FNP-BC
• Amy Long
• Sherie L Love, MD
• Katarinna Loych-Read, PA-C
• Shannon Lynch, RDN, LDN
• Saleh Ahmed Malik, DMD
• Anna Mamas, DPT
• Alex Philip Marchegiani, DC
• Sharlane Marcus, MHA
• Colleen L Marshall, CRNP

• Pediatrics Physician in Enola, PA
• Providers in Enola, PA by specialty
• Pediatrics Physician in Pennsylvania

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.