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Contact Information

W ANDREW MACKIE JR, PA-C
55 LAKE AVE N
WORCESTER, MA01655
 Phone: 508-334-8515
 Fax: 508-334-6490
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for W ANDREW MACKIE JR · (Male)

NPI Number 1245258441
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 07/17/2006
Last updated 10/28/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • MA License # PA2133
  • MA Medicaid 110108927A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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