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General NPI Number Information
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NPI Number | 1336106459
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Entity Type | Organization
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Legal Business Name | PHILLIP MAIDEN M.D.
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1704 NORTH RD SE
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City | WARREN
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State | OH
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Zip | 44484-2958
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Country | US
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Telephone | 330-707-0610
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Fax | 330-758-2862
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Provider Business Mailing Address
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Address Line | PO BOX 5384
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City | POLAND
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State | OH
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Zip | 44514-0384
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Country | US
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Telephone | 330-758-4515
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Fax | 330-758-2862
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP G MAIDEN
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Credential | M.D.
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Telephone | 330-758-4515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35063252M
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License Number State | OH
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