MEDICARE: DANIEL MAGLIOZZI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	MD60767812	WA

General Provider Information

NPI Number	:	1003236761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MAGLIOZZI MD

Provider Business Mailing Address
First Line	:	VA AMERICAN LAKE 9600 VETERANS DRIVE SOUTHWEST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98493-0003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA AMERICAN LAKE 9600 VETERANS DRIVE SOUTHWEST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98493-6560
Country	:	US
Telephone Number	:	215-589-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	02/26/2020

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