Provider Demographics
NPI:1679543243
Name:VITAGLIANO, MARGARET A (PA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:VITAGLIANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 E QUAIL TRACK DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8732
Mailing Address - Country:US
Mailing Address - Phone:480-538-7079
Mailing Address - Fax:
Practice Address - Street 1:12635 N 42ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7601
Practice Address - Country:US
Practice Address - Phone:602-494-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ738859Medicaid
AZ73619Medicare ID - Type Unspecified
AZP27073Medicare UPIN
AZ738859Medicaid