Provider Demographics
NPI:1548214901
Name:MAGNIFICO, BETH A (DO)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:MAGNIFICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-824-8185
Mailing Address - Fax:724-824-8191
Practice Address - Street 1:304 EVANS DR STE 201
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1493
Practice Address - Country:US
Practice Address - Phone:724-824-8185
Practice Address - Fax:724-824-8191
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007901L208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000001741740Medicaid
PA0000001741740Medicaid
G59822Medicare UPIN