1396716254 NPI number — DR. ALESIA L MADDEN DPM

Table of content: DR. ALESIA L MADDEN DPM (NPI 1396716254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396716254 NPI number — DR. ALESIA L MADDEN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDEN
Provider First Name:
ALESIA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MADDEN-RANDOLPH
Provider Other First Name:
ALESIA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396716254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4475 REGENCY PL
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20695-3072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-645-1406
Provider Business Mailing Address Fax Number:
301-645-0997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4475 REGENCY PL
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20695-3072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-645-1406
Provider Business Practice Location Address Fax Number:
301-645-0997
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  518 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 1138 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 757928400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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