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Individual

DR. SHADY MACARON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
56 FRANKLIN ST, WATERBURY, CT 06706-1253
(203) 709-6000
Mailing address
56 FRANKLIN ST, WATERBURY, CT 06706-1253
(203) 709-6000

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
045869
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
045869
CONNECTICARE
CT
01
969161
AETNA
01
PENDING
RR MEDICARE
CT
Enumeration date
12/07/2007
Last updated
10/28/2021
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