Active NPI
Avram Mack
- Psychiatry Physician
- Philadelphia, PA
National Provider Identifier
1811972573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD456188
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104 - Phone
- (215) 590-7555
- NPI assigned
- Dec 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 35487 | DC | |
| Psychiatry Physician | 2084P0800X | MD456188 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104
Mailing address
3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-7555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00706932 | Other | DC | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35487 | DC | MD | Psychiatry Physician |
| MD456188 | PA | MD | Psychiatry Physician |
Interoperability endpoints
- amack121718@direct.nemours.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456963200000",
"number": "1811972573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-7555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-7555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "AVRAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-14",
"last_updated": "2016-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "DC",
"license": "35487",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD456188",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00706932",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.