The distribution, population size and breeding density of the Egyptian Vulture Neophron percnopterus in Macedonia have been studied in two periods, 1983-1991 and 2003-2011. Results show that its population experienced decline of about 83% for the period of 30 years, counting only 22-23 pairs in 2011. The decrease has been steepest for the period 1991-2002 (-60.4%), and is mostly owing to single mass poisoning incident. Based on the overlap of the home ranges, breeding territories were grouped in clusters, and were non-randomly distributed within the clusters. Within the largest cluster, the nearest neighbor distance has significantly increased between the beginning and end of the study (from 2668.88 m to 7231.74 m in averages), and breeding density fell from 1.29 to 0.60 pairs/100 km(2). Breeding parameters (2006-2011) were similar to the previous studies - productivity (0.84 +/- 0.2), breeding success (0.93 +/- 0.2) and the fledging rate (1.19 +/- 0.16). Poisoning is considered as the primary reason for population decrease, and posed the most serious threat for the breeding population. It was also noted that some of the pairs do not return to the breeding territories, indicating possible losses along migration routes and/or in wintering regions. Urgent conservation measures are needed to safeguard the species in Macedonia, primarily by restricting the use of poison baits, which are the most important non-natural mortality factor.