Provider Demographics
NPI:1467528042
Name:MACFARLANE, MARY CORDNER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CORDNER
Last Name:MACFARLANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WILLOW GROUSE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1247
Mailing Address - Country:US
Mailing Address - Phone:907-457-3738
Mailing Address - Fax:
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5930
Practice Address - Country:US
Practice Address - Phone:907-452-1761
Practice Address - Fax:907-451-3321
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1161Medicaid
AKMD1161Medicaid
AKMD1161Medicaid
AKE57549Medicare UPIN