MEDICARE: MR. LARRY E MAGLICCO PTA

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	170100000X	Ph.D. Medical Genetics	TE000586L	PA

General Provider Information

NPI Number	:	1790992717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY E MAGLICCO PTA

Provider Business Mailing Address
First Line	:	231 KAREN DR
Second Line	:
City	:	ELIZABETH
State	:	PA
Zip	:	15037-2406
Country	:	US
Telephone Number	:	412-751-4118
Fax Number	:

Provider Business Practice Location Address
First Line	:	UPMC MCKEESPORT HOSPITAL
Second Line	:	1500 FITH AVE
City	:	MCKEESPORT
State	:	PA
Zip	:	15133
Country	:	US
Telephone Number	:	412-664-2221
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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