Provider Demographics
NPI:1720103351
Name:PACKARD, ANN MAURINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MAURINE
Last Name:PACKARD
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 1:532 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7602
Mailing Address - Country:US
Mailing Address - Phone:212-717-0896
Mailing Address - Fax:212-746-7323
Practice Address - Street 1:532 E 87TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-7602
Practice Address - Country:US
Practice Address - Phone:212-717-0896
Practice Address - Fax:212-746-7323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2010352080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY201035OtherMEDICAL LICENSE
E84140Medicare UPIN