Provider Demographics
NPI:1891973947
Name:SHARON L MACKO MD PA
Entity Type:Organization
Organization Name:SHARON L MACKO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MACKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-991-3660
Mailing Address - Street 1:13827 SPRUCEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-3636
Mailing Address - Country:US
Mailing Address - Phone:972-991-3660
Mailing Address - Fax:
Practice Address - Street 1:13827 SPRUCEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-3636
Practice Address - Country:US
Practice Address - Phone:972-991-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty