Provider Demographics
NPI:1639207780
Name:MACKER, MANJIT KAUR (MD)
Entity Type:Individual
Prefix:MRS
First Name:MANJIT
Middle Name:KAUR
Last Name:MACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MANJIT
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:317 LYNN MANOR DRIVE
Mailing Address - Street 2:317
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4427
Mailing Address - Country:US
Mailing Address - Phone:301-610-9323
Mailing Address - Fax:301-372-1835
Practice Address - Street 1:9400 SURRATTS RD
Practice Address - Street 2:RICA SOUTHERN MARYLAND
Practice Address - City:CHELTENHAM
Practice Address - State:MD
Practice Address - Zip Code:20623-1324
Practice Address - Country:US
Practice Address - Phone:301-372-1832
Practice Address - Fax:301-372-1835
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB2211Medicaid