Provider Demographics
NPI:1740286657
Name:CORPUZ, MACARIO CUDIAMAT JR (MD)
Entity type:Individual
Prefix:DR
First Name:MACARIO
Middle Name:CUDIAMAT
Last Name:CORPUZ
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-9099
Practice Address - Country:US
Practice Address - Phone:978-355-6321
Practice Address - Fax:978-355-6549
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2110865Medicaid
MAH44281Medicare UPIN
MASX3782Medicare PIN