MEDICARE: JOHN JOSEPH MALIZIA CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN508476L	PA

General Provider Information

NPI Number	:	1023014701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH MALIZIA CRNA

Provider Business Mailing Address
First Line	:	540 MOCKINGBIRD WAY
Second Line	:
City	:	WARRINGTON
State	:	PA
Zip	:	18976-3017
Country	:	US
Telephone Number	:	215-491-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	RED LION AND KNIGHTS ROADS
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115
Country	:	US
Telephone Number	:	215-612-4088
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	01/23/2008

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