Healthcare Provider Details

I. General information

NPI: 1386647345
Provider Name (Legal Business Name): GEORGE A MACONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE STE 710 STE 710
SAINT LOUIS MO
63108-1402
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8064
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8181
  • Fax: 314-747-1429
Mailing address:
  • Phone: 314-454-8181
  • Fax: 314-884-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2005039932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: