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Individual

ANDREW MACKO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
1150 NEW LONDON AVE, CRANSTON, RI 02920-3036
(401) 270-3232
(401) 383-9480
Mailing address
1150 NEW LONDON AVE, CRANSTON, RI 02920-3036
(401) 270-3232
(401) 383-9480

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00295
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7010647
RI
01
9790039451
MEDICARE PTAN
RI
Enumeration date
03/03/2006
Last updated
02/19/2011
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