Provider Demographics
NPI:1881615003
Name:MACISAAC FAMILY MEDICINE
Entity type:Organization
Organization Name:MACISAAC FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MACISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-940-9190
Mailing Address - Street 1:2000 CORPORATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7609
Mailing Address - Country:US
Mailing Address - Phone:724-940-9190
Mailing Address - Fax:724-940-9195
Practice Address - Street 1:125 WARRENDALE BAYNE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7570
Practice Address - Country:US
Practice Address - Phone:724-940-9191
Practice Address - Fax:724-940-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER
=========OtherTAX ID NUMBER