Provider Demographics
NPI:1407841471
Name:NEUWIRTH, MACELLE L (MD)
Entity type:Individual
Prefix:DR
First Name:MACELLE
Middle Name:L
Last Name:NEUWIRTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5757 W THUNDERBIRD RD
Mailing Address - Street 2:E 255
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4641
Mailing Address - Country:US
Mailing Address - Phone:602-843-1991
Mailing Address - Fax:602-843-3224
Practice Address - Street 1:6780 W THUNDERBIRD RD # A101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5049
Practice Address - Country:US
Practice Address - Phone:602-843-1991
Practice Address - Fax:602-843-3224
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ34319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ951170Medicaid