Provider Demographics
NPI:1033193750
Name:MACEK, JAMES M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:MACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PAYSON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1309
Mailing Address - Country:US
Mailing Address - Phone:508-772-1438
Mailing Address - Fax:
Practice Address - Street 1:15 PAYSON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1309
Practice Address - Country:US
Practice Address - Phone:508-772-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06712Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
RIJM47990Medicare ID - Type UnspecifiedRI MA PROVIDER NUMBER
RI007056851Medicare ID - Type UnspecifiedRI PROVIDER NUMBER
RIB77092Medicare UPIN