Provider Demographics
NPI:1790739654
Name:MACCABE, JONATHAN E (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:MACCABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6301 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5701
Mailing Address - Country:US
Mailing Address - Phone:912-352-8700
Mailing Address - Fax:912-650-6805
Practice Address - Street 1:25 HOSPITAL CENTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2739
Practice Address - Country:US
Practice Address - Phone:843-682-2800
Practice Address - Fax:843-682-2828
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC28629207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCC2049OtherRAILROAD MEDICARE
SCAA13254768Medicare PIN
H61376Medicare UPIN
SCAA1325E470Medicare PIN