Provider Demographics
NPI:1386621100
Name:MACCHIO, GREGORY J (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:MACCHIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27401 LOS ALTOS
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6316
Mailing Address - Country:US
Mailing Address - Phone:949-582-9624
Mailing Address - Fax:949-582-9626
Practice Address - Street 1:27700 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6426
Practice Address - Country:US
Practice Address - Phone:949-364-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01044919A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200112130Medicaid
CAG88576OtherCA LICENSE
IN236080VMedicare ID - Type Unspecified
IN200112130Medicaid