Provider Demographics
NPI:1154196756
Name:MAROTTA, MADELINE PATRICIA (PA-C)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:PATRICIA
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:MAROTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1492 S MILL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5660
Mailing Address - Country:US
Mailing Address - Phone:480-834-7546
Mailing Address - Fax:
Practice Address - Street 1:1492 S MILL AVE STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5660
Practice Address - Country:US
Practice Address - Phone:480-834-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-24
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ10074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program