Healthcare Provider Details

I. General information

NPI: 1881615003
Provider Name (Legal Business Name): MACISAAC FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WARRENDALE BAYNE RD SUITE 200
WARRENDALE PA
15086-7570
US

IV. Provider business mailing address

2000 CORPORATE DR STE 100
WEXFORD PA
15090-7609
US

V. Phone/Fax

Practice location:
  • Phone: 724-940-9191
  • Fax: 724-940-9195
Mailing address:
  • Phone: 724-940-9190
  • Fax: 724-940-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID B MACISAAC
Title or Position: PHYSICAN
Credential: DO
Phone: 724-940-9190