| Doctor Name: | DR. MATTHEW D MACK |
| NPI Number: | 1770506958 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 252075 |
| Business Practice Address: | 340 Arnett Blvd Rochester, NY - 146191147 |
| Business Phone Number: | 5852352250 |
| Business Fax Number: | 5852350011 |
| Mailing Address: | 180 Mount Vernon Ave, ROCHESTER |
| State: | NY |
| Postal Code: | 146202344 |
| Phone Number: | 5857473297 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 252075 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |