Provider Demographics
NPI:1972897825
Name:MACER, MATTHEW LATHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LATHAM
Last Name:MACER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 YORK ST # T-209
Mailing Address - Street 2:YALE-NEW HAVEN HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2259
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:550 DEEP VALLEY DR STE 287
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-7600
Practice Address - Country:US
Practice Address - Phone:310-541-8400
Practice Address - Fax:310-541-7900
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2019-02-12
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Provider Licenses
StateLicense IDTaxonomies
CAA137504207V00000X, 208600000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty