Provider Demographics
NPI:1720387319
Name:MACIAS, CARLOS AITOR (MD, MPH, FACS)
Entity Type:Individual
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First Name:CARLOS
Middle Name:AITOR
Last Name:MACIAS
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Gender:M
Credentials:MD, MPH, FACS
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Mailing Address - Street 1:254 EASTON AVE.
Mailing Address - Street 2:DEPT. OF SURGERY, 4TH FLOOR, MEDICAL OFFICE BUILDING
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-745-8571
Mailing Address - Fax:732-214-1107
Practice Address - Street 1:254 EASTON AVE.
Practice Address - Street 2:DEPT. OF SURGERY, 4TH FLOOR, MEDICAL OFFICE BUILDING
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-745-8571
Practice Address - Fax:732-214-1107
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0456208600000X
NC2013-01981208600000X
NJ25MA09005600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery