Provider Demographics
NPI:1184798167
Name:MACEDONIA, DOMINIC ANTHONY (MD)
Entity type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:ANTHONY
Last Name:MACEDONIA
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 1:523 NORTH FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952
Mailing Address - Country:US
Mailing Address - Phone:740-282-1144
Mailing Address - Fax:740-282-2374
Practice Address - Street 1:523 NORTH FOURTH ST
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952
Practice Address - Country:US
Practice Address - Phone:740-282-1144
Practice Address - Fax:740-282-2374
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031012M2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV740023Medicaid
OH0286051Medicaid
OH35031012MOtherLICENSE
OH35031012MOtherLICENSE
C01250Medicare UPIN