Provider Demographics
NPI:1386265288
Name:AVILA MACIAS, VICTOR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:AVILA MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2215 GENESEE ST RM 105
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:111 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2517
Practice Address - Country:US
Practice Address - Phone:315-917-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325202207Q00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program