Provider Demographics
NPI:1477021996
Name:MACKAY, ADRIAN LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LEE
Last Name:MACKAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-4713
Mailing Address - Country:US
Mailing Address - Phone:202-215-1636
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2010
Practice Address - Country:US
Practice Address - Phone:424-274-3211
Practice Address - Fax:888-564-8025
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant