Provider Demographics
NPI:1922461052
Name:MAGDIC, MATTHEW (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MAGDIC
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2756
Mailing Address - Country:US
Mailing Address - Phone:723-228-1303
Mailing Address - Fax:724-228-1513
Practice Address - Street 1:764 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2756
Practice Address - Country:US
Practice Address - Phone:723-228-1303
Practice Address - Fax:724-228-1513
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP015936OtherSTATE LICENSE
PAW16022745MOtherDEA