Provider Demographics
NPI:1437133378
Name:MACELWEE, MARK M (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:M
Last Name:MACELWEE
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 1:555 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6312
Mailing Address - Country:US
Mailing Address - Phone:970-586-2200
Mailing Address - Fax:970-577-4536
Practice Address - Street 1:2525 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-344-1119
Practice Address - Fax:602-344-1112
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR40558208M00000X
AZ26806208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ455643Medicaid
CO56488521Medicaid
AZP00172747OtherRAILROAD MEDICARE
AZ86080015085259A966OtherTRIWEST
G85622Medicare UPIN
CO56488521Medicaid
AZ455643Medicaid