Provider Demographics
NPI:1114015633
Name:MAGGIULLI, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MAGGIULLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6966 W BERGEN
Mailing Address - Street 2:
Mailing Address - City:BERGEN
Mailing Address - State:NY
Mailing Address - Zip Code:14416
Mailing Address - Country:US
Mailing Address - Phone:585-494-1300
Mailing Address - Fax:585-494-1132
Practice Address - Street 1:16 BANK ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2250
Practice Address - Country:US
Practice Address - Phone:585-815-6760
Practice Address - Fax:585-344-7370
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY13475207Q00000X
NY134751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0108596OtherINDEPENDENT HEALTH
0793OtherUNIVERA
MDA129OtherPREFERRED CARE
P010134751OtherRIPA
P010134751OtherEXCELLUS
0000508058001OtherBC BS OF WNY
04481310OtherMEDICADE
22180OtherEMPIRE
7331260OtherAETNA
P010134751OtherEXCELLUS