1528012523 NPI number — DR. FRANKLIN W MADDUX MD

Table of content: DR. FRANKLIN W MADDUX MD (NPI 1528012523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528012523 NPI number — DR. FRANKLIN W MADDUX MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDUX
Provider First Name:
FRANKLIN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528012523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 1360
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-792-1433
Provider Business Mailing Address Fax Number:
434-797-2807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-792-1433
Provider Business Practice Location Address Fax Number:
434-797-2807
Provider Enumeration Date:
05/22/2006

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: 207RN0300X , with the licence number:  0101043362 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 28721 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 171806 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0071722 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 327789 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 809560K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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