Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | TE000586L | PA |
NPI | 1790992717 |
---|---|
Provider Name | Mr. Larry E Maglicco |
First Address | Elizabeth, PA 15037-2406 |
Second Address | Mckeesport, PA 15133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |