Provider Demographics
NPI:1780882670
Name:MACALUSO, KATIE J (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:J
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-409-2020
Mailing Address - Fax:
Practice Address - Street 1:39 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2035
Practice Address - Country:US
Practice Address - Phone:585-409-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012014709207W00000X
KS04-35741207W00000X
NY261390207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4050A0009Medicare UPIN
MO4050D0008Medicare UPIN
KS405E00013Medicare UPIN
MO4050H0008Medicare UPIN