Provider Demographics
NPI:1760782239
Name:HOLLY J MAGGIANO MD INC
Entity Type:Organization
Organization Name:HOLLY J MAGGIANO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-856-5003
Mailing Address - Street 1:983 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2555
Mailing Address - Country:US
Mailing Address - Phone:330-856-5003
Mailing Address - Fax:330-856-9224
Practice Address - Street 1:983 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2555
Practice Address - Country:US
Practice Address - Phone:330-856-5003
Practice Address - Fax:330-856-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350657052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0981737Medicaid
OHF79395Medicare UPIN
OH0981737Medicaid