Provider Demographics
NPI:1699263954
Name:MACZIS, PUJA GOSAI (PA)
Entity type:Individual
Prefix:
First Name:PUJA
Middle Name:GOSAI
Last Name:MACZIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PUJA
Other - Middle Name:G
Other - Last Name:GOSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1002 N CHURCH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1449
Mailing Address - Country:US
Mailing Address - Phone:336-387-8100
Mailing Address - Fax:336-387-8202
Practice Address - Street 1:1002 N CHURCH ST STE 302
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1449
Practice Address - Country:US
Practice Address - Phone:336-387-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant