Healthcare Provider Details

I. General information

NPI: 1548214901
Provider Name (Legal Business Name): BETH A MAGNIFICO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 EVANS DR STE 401
ELLWOOD CITY PA
16117-1478
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-824-8185
  • Fax: 724-824-8191
Mailing address:
  • Phone: 724-824-8185
  • Fax: 724-824-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS007901L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS007901L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: