Basic Information
| Provider Information | |||||||||
| NPI: | 1467554642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 ASHVILLE AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198591136 | ||||||||
| FaxNumber: | 9198594240 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 ASHVILLE AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198591136 | ||||||||
| FaxNumber: | 9198594240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | 9300214 | NC | X | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | 9300214 | NC | X | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2190963K | 01 | MEDICARE CIGNA | OTHER | 1350Y | 01 | BCBS | OTHER | 185373 | 01 | MEDICOST | OTHER | 3131308 | 01 | CIGNA | OTHER |