Provider Demographics
NPI:1528185089
Name:MACK, SAMANTHA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:MACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELIZABETH
Other - Last Name:HOHENSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:849 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4027
Mailing Address - Country:US
Mailing Address - Phone:303-437-5480
Mailing Address - Fax:
Practice Address - Street 1:6116 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5703
Practice Address - Country:US
Practice Address - Phone:303-839-6851
Practice Address - Fax:303-869-1786
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49720207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology