1851326011 NPI number — DAVID L MADISON MD

Table of content: DAVID L MADISON MD (NPI 1851326011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851326011 NPI number — DAVID L MADISON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADISON
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
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:
1851326011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4880 CENTURY PLAZA RD
Provider Second Line Business Mailing Address:
# 905
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46254-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-279-6314
Provider Business Mailing Address Fax Number:
317-947-2698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4880 CENTURY PLAZA RD
Provider Second Line Business Practice Location Address:
# 905
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46254-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-279-6314
Provider Business Practice Location Address Fax Number:
317-947-2698
Provider Enumeration Date:
07/12/2006

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: 2086S0129X , with the licence number:  01031866A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100326060A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000083157 . This is a "BCBS PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 760000004 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com