Basic Information
| Provider Information | |||||||||
| NPI: | 1720387319 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACIAS | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | AITOR | ||||||||
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| Credential: | MD, MPH, FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 254 EASTON AVE. | ||||||||
| Address2: | DEPT. OF SURGERY, 4TH FLOOR, MEDICAL OFFICE BUILDING | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327458571 | ||||||||
| FaxNumber: | 7322141107 | ||||||||
| Practice Location | |||||||||
| Address1: | 254 EASTON AVE. | ||||||||
| Address2: | DEPT. OF SURGERY, 4TH FLOOR, MEDICAL OFFICE BUILDING | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327458571 | ||||||||
| FaxNumber: | 7322141107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2011 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD2015-0456 | NM | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2013-01981 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MA09005600 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.