Basic Information
| Provider Information | |||||||||
| NPI: | 1144364746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072837000 | ||||||||
| FaxNumber: | 2072829128 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GRANNY SMITH COURT | ||||||||
| Address2: | |||||||||
| City: | OLD ORCHARD BEACH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079347276 | ||||||||
| FaxNumber: | 2079340465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 28697 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD19743 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004760 | 01 | KAISER-COMMERCIAL NUMBER | OTHER | 75350882 | 05 | CO | MEDICAID |