Provider Demographics
NPI:1942418132
Name:MAFFI PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:MAFFI PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAFFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-505-6430
Mailing Address - Street 1:5410 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE E-200
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5927
Mailing Address - Country:US
Mailing Address - Phone:480-505-6430
Mailing Address - Fax:480-505-6429
Practice Address - Street 1:5410 N SCOTTSDALE RD
Practice Address - Street 2:SUITE E-200
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5927
Practice Address - Country:US
Practice Address - Phone:480-505-6430
Practice Address - Fax:480-505-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32805208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0768540OtherBC OF AZ PROVIDER NUMBER
AZ868292Medicaid
AZ868292Medicaid
AZ101786Medicare ID - Type Unspecified