Provider Demographics
NPI:1780673335
Name:MAFFEO, ALPHONSE (MD)
Entity Type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:
Last Name:MAFFEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 W TILGHMAN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9130
Mailing Address - Country:US
Mailing Address - Phone:484-866-9583
Mailing Address - Fax:610-366-1147
Practice Address - Street 1:4905 W TILGHMAN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9130
Practice Address - Country:US
Practice Address - Phone:484-866-9583
Practice Address - Fax:610-366-1147
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019125E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007170420001Medicaid
PA066538OtherHIGHMARK
PA1004241OtherAMERIHEALTH MERCY
PA0066538OtherKHP CENTRAL
PA00717042OtherGATEWAY
PA0000000130118OtherTHREE RIVERS
PA1004241OtherKEYSTONE MERCY
PA0040554000OtherINDEP. BLUE CROSS
PA00717042OtherGATEWAY
PAC28800Medicare UPIN
PA0000000130118OtherTHREE RIVERS