Individual
RICHARD HENRY MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 FAIRMOUNT AVE, SUITE 530, BALTIMORE, MD 21286-5466
(410) 494-1389
(410) 494-1386
Mailing address
515 FAIRMOUNT AVE, CREDENTIALING DEPARTMEN, TOWSON, MD 21286-5466
(410) 494-1324
(410) 494-1361
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D07902
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308331400
—
MD
Enumeration date
04/26/2006
Last updated
06/17/2008
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