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NPI Code Detail

MEDICARE: PHILLIP MAIDEN M.D.

MEDICARE: PHILLIP MAIDEN M.D.
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
12084P0800XPsychiatry Physician35063252MOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336106459
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHILLIP MAIDEN M.D.
Provider Business Mailing Address
First Line : PO BOX 5384
Second Line :
City : POLAND
State : OH
Zip : 44514-0384
Country : US
Telephone Number : 330-758-4515
Fax Number : 330-758-2862
Provider Business Practice Location Address
First Line : 1704 NORTH RD SE
Second Line :
City : WARREN
State : OH
Zip : 44484-2958
Country : US
Telephone Number : 330-707-0610
Fax Number : 330-758-2862
Authorized Official
Title or Position : OWNER
Name : PHILLIP G MAIDEN
Credential : M.D.
Telephone Number : 330-758-4515
Provider Enumeration Date : 05/01/2006
Last Update Date : 08/22/2020

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