Provider Demographics
NPI:1245412402
Name:FORTUNATO R MACATOL
Entity Type:Organization
Organization Name:FORTUNATO R MACATOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FORTUNATO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACATOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-374-1499
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0023
Mailing Address - Country:US
Mailing Address - Phone:740-373-3931
Mailing Address - Fax:740-373-3404
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-373-3931
Practice Address - Fax:740-373-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307840Medicaid
OH9279451Medicare PIN