Provider Demographics
NPI:1922023894
Name:MAXFIELD, JODI P (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:P
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:POWLUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:765 LIBERTY STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2568
Mailing Address - Country:US
Mailing Address - Phone:814-333-5888
Mailing Address - Fax:814-333-5026
Practice Address - Street 1:765 LIBERTY STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2568
Practice Address - Country:US
Practice Address - Phone:814-333-5888
Practice Address - Fax:814-333-5026
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417934207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019009800001Medicaid
310927OtherUPMC
1379522OtherBLUE SHIELD
058144MQWMedicare ID - Type Unspecified
1379522OtherBLUE SHIELD