Provider Demographics
NPI:1255494498
Name:MACAOAY, SUSANA (PAC)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:MACAOAY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 WASHINGTON ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5779
Mailing Address - Country:US
Mailing Address - Phone:410-840-0420
Mailing Address - Fax:410-840-0756
Practice Address - Street 1:826 WASHINGTON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5779
Practice Address - Country:US
Practice Address - Phone:410-840-0420
Practice Address - Fax:410-840-0756
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002941207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q65139Medicare UPIN
MD155MN426Medicare ID - Type Unspecified