Healthcare Provider Details

I. General information

NPI: 1992775373
Provider Name (Legal Business Name): JAMES R MACIELAK M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11277 VERNON PLACE SUITE 200
MEADVILLE PA
16335-3717
US

IV. Provider business mailing address

11277 VERNON PLACE SUITE 200
MEADVILLE PA
16335-3717
US

V. Phone/Fax

Practice location:
  • Phone: 814-724-1252
  • Fax: 814-333-8871
Mailing address:
  • Phone: 814-724-1252
  • Fax: 814-333-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD027764E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: