Healthcare Provider Details

I. General information

NPI: 1316920960
Provider Name (Legal Business Name): DRAGOS MACELARU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6119 US HIGHWAY 11
CANTON NY
13617-3991
US

IV. Provider business mailing address

50 LEROY ST
POTSDAM NY
13676-1786
US

V. Phone/Fax

Practice location:
  • Phone: 315-261-5850
  • Fax:
Mailing address:
  • Phone: 315-261-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01056828A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: