Provider Demographics
NPI:1982634341
Name:MACKOUL, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MACKOUL
Suffix:
Gender:M
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:PO BOX 37230
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3230
Mailing Address - Country:US
Mailing Address - Phone:410-990-4480
Mailing Address - Fax:410-990-4484
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:STE 414
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:410-990-4480
Practice Address - Fax:410-990-4484
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047612207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD14690290Medicaid
MDF58477Medicare UPIN
MD14690290Medicaid
MD281P587GMedicare PIN
MD281PMedicare PIN