MEDICARE: DR. TADD MAXFIELD DO

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	207Q00000X	Family Medicine Physician	58-02259	OH
2	207Q00000X	Family Medicine Physician	34.009148	OH

General Provider Information

NPI Number	:	1477769032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TADD MAXFIELD DO

Provider Business Mailing Address
First Line	:	855 W MAPLE ST
Second Line	:	STE 120
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 HILLCREST DR
Second Line	:	SUITE 3
City	:	ASHLAND
State	:	OH
Zip	:	44805-4052
Country	:	US
Telephone Number	:	330-877-6613
Fax Number	:	330-877-6618

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/29/2012

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Directions to “ DR. TADD MAXFIELD DO” Practice Location

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