Provider Demographics
NPI:1235686585
Name:MAGGARD, AMY (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1562
Mailing Address - Country:US
Mailing Address - Phone:740-446-5000
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:4439 STATE ROUTE 159 STE G10
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7708
Practice Address - Country:US
Practice Address - Phone:740-779-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-03
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013278208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0285213Medicaid