Basic Information
| Provider Information | |||||||||
| NPI: | 1285193318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 599 ARCOLA RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194263954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845801000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 599 ARCOLA RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194263954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845801000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2019 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | OS022067 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1036634580001 | 05 | PA | MEDICAID |