Basic Information
| Provider Information | |||||||||
| NPI: | 1508975152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 274 | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | 2074953353 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 CLEMENT WAY | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | 2074953353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 03/30/2010 | ||||||||
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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 | 207Q00000X | EC05196 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 432682499 | 05 | ME | MEDICAID |