Individual
JOAN MINETTE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 LANSDOWNE AVE, DARBY, PA 19023-1200
(610) 237-4814
Mailing address
20 CONSHOHOCKEN STATE RD, APT 406, BALA CYNWYD, PA 19004-3335
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD030223E
PA
208D00000X
General Practice Physician
Primary
MD 030223-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012594240014
—
PA
Enumeration date
06/02/2006
Last updated
08/28/2015
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