Provider Demographics
NPI:1891857728
Name:MACATOL, FORTUNATO R (MD)
Entity type:Individual
Prefix:
First Name:FORTUNATO
Middle Name:R
Last Name:MACATOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-374-8790
Mailing Address - Fax:740-374-1766
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-374-1499
Practice Address - Fax:740-374-1766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035999207ZP0102X
WV15831207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0102187000Medicaid
OH0524561Medicaid
OH0537542Medicare PIN
A80724Medicare UPIN