Provider Demographics
NPI:1245619105
Name:MACKIN, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MACKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1819 ELECTRIC RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1605
Mailing Address - Country:US
Mailing Address - Phone:540-855-5120
Mailing Address - Fax:540-342-4373
Practice Address - Street 1:1819 ELECTRIC RD STE 1B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1605
Practice Address - Country:US
Practice Address - Phone:540-855-5120
Practice Address - Fax:540-342-4373
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COTL.0006375207W00000X
IL036.149405207WX0107X
VA0101271654207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology