Provider Demographics
NPI:1669130373
Name:MACRI, JOHN ALBERT IV (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:MACRI
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201A N CHURCH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1479
Mailing Address - Country:US
Mailing Address - Phone:570-455-8544
Mailing Address - Fax:
Practice Address - Street 1:1201A N CHURCH ST STE 103
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1479
Practice Address - Country:US
Practice Address - Phone:570-455-8544
Practice Address - Fax:570-455-8554
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063264363AS0400X
PAOA007280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical