Provider Demographics
NPI:1790992717
Name:MAGLICCO, LARRY E (PTA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:E
Last Name:MAGLICCO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2406
Mailing Address - Country:US
Mailing Address - Phone:412-751-4118
Mailing Address - Fax:
Practice Address - Street 1:UPMC MCKEESPORT HOSPITAL
Practice Address - Street 2:1500 FITH AVE
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15133
Practice Address - Country:US
Practice Address - Phone:412-664-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000586L170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics