Organization
MACK PEDIATRICS PLLC
Active
Other names
Mack Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMILI RACHELE MACK MD (PHYSICIAN, OWNER)
(919) 825-3600
Entity
Organization
Contact information
Practice address
3721 LYNN RD STE 104, RALEIGH, NC 27613-3855
(919) 825-3600
(984) 200-6001
Mailing address
3721 LYNN RD STE 104, RALEIGH, NC 27613-3855
(919) 825-3600
(984) 200-6001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34D2157235
CLIA LABORATORY PROGRAM
NC
Enumeration date
10/09/2018
Last updated
04/30/2019
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