Individual
DR. MICHAEL MACCIOCCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 E LANCASTER AVE, WYNNEWOOD, PA 19096
(484) 476-1000
(484) 476-9000
Mailing address
100 E LANCASTER AVE, WYNNEWOOD, PA 19096-3450
(484) 476-1000
(484) 476-9000
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
25MA09075400
NJ
207RI0011X
Interventional Cardiology Physician
Primary
MD444353
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
343723DQU
MEDICARE
NJ
05
—
MT195033
—
PA
Enumeration date
06/03/2009
Last updated
06/28/2018
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