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NPI Code Detail

MEDICARE: MR. JOSEPH DOUGLAS MACUT PA-C

MEDICARE: MR. JOSEPH DOUGLAS MACUT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMA 000412LPA

General Provider Information

NPI Number : 1326260159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH DOUGLAS MACUT PA-C
Provider Business Mailing Address
First Line : 3940 LOCUST LN
Second Line :
City : HARRISBURG
State : PA
Zip : 17109-4023
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3940 LOCUST LN
Second Line :
City : HARRISBURG
State : PA
Zip : 17109-4023
Country : US
Telephone Number : 717-545-5787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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