Individual
MS. CAROL JEAN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1850 M ST NW, SUITE 450, WASHINGTON, DC 20036-5803
(202) 293-1000
Mailing address
1106 NORRIS CT SW, LEESBURG, VA 20175-4361
(703) 669-9343
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA30161
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA30161
STATE LICENSE
DC
Enumeration date
11/30/2006
Last updated
07/08/2007
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