Provider Demographics
NPI:1750382297
Name:MACAULAY, BRIAN WAYNE (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WAYNE
Last Name:MACAULAY
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 1:1602 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3310
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:116 HILLS PLZ
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2438
Practice Address - Country:US
Practice Address - Phone:304-720-4466
Practice Address - Fax:304-720-4815
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
14811OtherHEALTH PLAN OF UPPER OH V
WV55035705700OtherWV COMPENSATION
WV0052239000Medicaid
001718160OtherMOUNTAIN STATE BCBS
OH2043621Medicaid
WVWV0483EMedicare PIN
WVWV0483B279Medicare PIN
WVWV0483DMedicare PIN
080098275Medicare PIN
WV0052239000Medicaid
WVWV0483AMedicare PIN
WVWV0483FMedicare PIN
WV7163751Medicare PIN
WV55035705700OtherWV COMPENSATION
WVWV0483CMedicare PIN
WV7329011Medicare PIN