Provider Demographics
NPI:1093759086
Name:MACCHI, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MACCHI
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 1:4411 BEE RIDGE RD
Mailing Address - Street 2:#357
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-462-2696
Mailing Address - Fax:941-462-2696
Practice Address - Street 1:4411 BEE RIDGE RD
Practice Address - Street 2:#357
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-462-2696
Practice Address - Fax:941-462-2696
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME490832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379374500Medicaid
D51423Medicare UPIN
FLD51423Medicare UPIN
FL379374500Medicaid
FL05795TMedicare PIN
FL05795UMedicare PIN