Provider Demographics
NPI:1437181336
Name:MACISAAC, DAVID B (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:MACISAAC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7611
Mailing Address - Country:US
Mailing Address - Phone:724-940-9190
Mailing Address - Fax:724-940-9195
Practice Address - Street 1:2000 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7611
Practice Address - Country:US
Practice Address - Phone:724-940-9190
Practice Address - Fax:724-940-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81943Medicare UPIN
PA068983Medicare PIN