Provider Demographics
NPI:1649219585
Name:MACATUNO, EDIFEL N (MD)
Entity type:Individual
Prefix:
First Name:EDIFEL
Middle Name:N
Last Name:MACATUNO
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6287
Practice Address - Fax:864-560-7091
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCM235752080A0000X
SC235752080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCC5085019OtherMEDICARE PIN
SCSCC508H895OtherMEDICARE PIN
SC235757Medicaid
SCSCC508J577OtherMEDICARE PIN