Provider Demographics
NPI:1902883754
Name:MADDEN, RENEE M (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PL # MS 515
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3300
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40553208000000X
AZ375872080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150215502Medicaid
TX150215503OtherCSN
TNQ020362Medicaid
AL009934486Medicaid
OK200071130AMedicaid
MO207368903Medicaid
TX8CL613OtherBCBS
MS02750818Medicaid
IA0717173Medicaid
KS200378480AMedicaid
TN5440667Medicaid
AR158594001Medicaid
IN200803590AMedicaid
TN5440667Medicaid
AR158594001Medicaid
TNQ020362Medicaid