Provider Demographics
NPI:1487493243
Name:MACZUBA, CHLOE ROSE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:ROSE
Last Name:MACZUBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ROBERTS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2881
Mailing Address - Country:US
Mailing Address - Phone:603-339-6637
Mailing Address - Fax:
Practice Address - Street 1:39 ROBERTS ST APT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2881
Practice Address - Country:US
Practice Address - Phone:603-339-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant