Healthcare Provider Details

I. General information

NPI: 1356388656
Provider Name (Legal Business Name): AMY A MADDALENA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CLAIRTON BLVD
PITTSBURGH PA
15236-4567
US

IV. Provider business mailing address

810 CLAIRTON BLVD
PITTSBURGH PA
15236-4567
US

V. Phone/Fax

Practice location:
  • Phone: 412-466-5004
  • Fax: 412-466-7137
Mailing address:
  • Phone: 412-466-5004
  • Fax: 412-466-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS-012399
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: