Healthcare Provider Details

I. General information

NPI: 1952447997
Provider Name (Legal Business Name): JOSE S MACEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VALLEY GREEN LN STE 610
KING OF PRUSSIA PA
19406-2080
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 484-685-3045
  • Fax: 484-685-3046
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD073265L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD073265L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: