Provider Demographics
NPI:1437649811
Name:MACKOW, NATALIE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ANNE
Last Name:MACKOW
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 1:101 NICOLLS RD # T16-060
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8153
Mailing Address - Country:US
Mailing Address - Phone:631-444-3490
Mailing Address - Fax:631-444-7518
Practice Address - Street 1:101 NICOLLS RD # T16-060
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-4220
Practice Address - Country:US
Practice Address - Phone:631-444-3490
Practice Address - Fax:631-444-7518
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336041207RI0200X
NC2021-00997207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease