Provider Demographics
NPI:1275792087
Name:MACEDO, AISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AISHA
Middle Name:
Last Name:MACEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MEDICAL PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4053
Mailing Address - Country:US
Mailing Address - Phone:301-681-6600
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-681-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68933207W00000X
NY245801-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022610600Medicaid
MD155169YYUMedicare PIN