Provider Demographics
NPI:1992761266
Name:MADDI, JOSEPH LEONARD (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEONARD
Last Name:MADDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1039
Mailing Address - Country:US
Mailing Address - Phone:716-834-0221
Mailing Address - Fax:716-834-0222
Practice Address - Street 1:4225 MAPLE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1039
Practice Address - Country:US
Practice Address - Phone:716-834-0221
Practice Address - Fax:716-834-0222
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149577-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01024840Medicaid
NY2107103OtherINDEPENDENT HEALTH
NY000502386008OtherBLUE CROSS BLUE SHIELD
NY00010108705OtherUNIVERA
NY01024840Medicaid
NY000502386008OtherBLUE CROSS BLUE SHIELD
NYRB6642Medicare PIN