Provider Demographics
NPI:1962476770
Name:LISTOPAD, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:LISTOPAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-3463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 NORTH ST
Practice Address - Street 2:
Practice Address - City:WEST MIDDLESEX
Practice Address - State:PA
Practice Address - Zip Code:16159-3463
Practice Address - Country:US
Practice Address - Phone:724-528-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003278L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE13899Medicare UPIN
PA160579PD7Medicare ID - Type Unspecified