Mack, Jonathan Eberhard

Mack, Jonathan Eberhard is an individual health care provider with primary practice located at 185 Queen City Ave Elliot Orthopaedic Surgery Specialists, Manchester NH 03101-7100. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Mack, Jonathan Eberhard can be contacted via phone (603) 625-1655.

Contact Information

Primary practice address
185 Queen City Ave Elliot Orthopaedic Surgery Specialists Manchester NH 03101-7100
Phone: (603) 625-1655
Fax: (603) 626-4686
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 33787 Arizona
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 50942 Wisconsin

Profile Details

NPI number 1275522625
LBN Legal business name Mack, Jonathan Eberhard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2005
Last updated Apr 13th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275522625 NPPES
Wisconsin MEDICAID 34952800

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