Provider Demographics
NPI:1629356191
Name:MAGGART, AMANDA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:MAGGART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:SCALISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:350 W WILSON BRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2590
Mailing Address - Country:US
Mailing Address - Phone:614-268-2323
Mailing Address - Fax:614-796-2901
Practice Address - Street 1:350 W WILSON BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2590
Practice Address - Country:US
Practice Address - Phone:614-796-2900
Practice Address - Fax:614-796-2901
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH044470Medicare PIN