Provider Demographics
NPI:1225031099
Name:MACY, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:MACY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7790 DAYTON SPRINGFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-1996
Mailing Address - Country:US
Mailing Address - Phone:937-399-7777
Mailing Address - Fax:937-399-6794
Practice Address - Street 1:7790 DAYTON SPRINGFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1996
Practice Address - Country:US
Practice Address - Phone:937-340-6440
Practice Address - Fax:937-340-6441
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-08-0461-M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000222542OtherANTHEM
OH0109435OtherUNITED HEALTH CARE
OH97569OtherNATIONWIDE
OH2314909Medicaid
OHOH0036839OtherTRICARE/CHAMPUS
OH7572352OtherAETNA
OH08018351OtherRR MEDICARE
OHOH0036839OtherTRICARE/CHAMPUS
OH08018351OtherRR MEDICARE