Provider Demographics
NPI:1558359935
Name:MAKOLO, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MAKOLO
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 1:105 STEVENS AVE
Mailing Address - Street 2:SUITE 609
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-663-6663
Mailing Address - Fax:
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 609
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-663-6663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190317207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2120827OtherOXFORD HEALTH PLAN
NY01897070Medicaid
9640822OtherG.H.I.
5248234003OtherCIGNA HEALTHCARE PPO
2466949OtherAETNA US HEALTHCARE HMO (
0000201801001OtherUNITED HEALTHCARE
7521135OtherAETNA US HEALTHCARE PPO
2475623OtherAETNA US HEALTHCARE HMO (
2C9321OtherHEALTHNET
524823030OtherCIGNA HEALTHCARE HMO
190317OtherHIP
5248234003OtherCIGNA HEALTHCARE PPO
NYEM092H4410Medicare ID - Type Unspecified