Provider Demographics
NPI:1144364746
Name:MADDEN, BETH A (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
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 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:207-282-9128
Practice Address - Street 1:1 GRANNY SMITH COURT
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064
Practice Address - Country:US
Practice Address - Phone:207-934-7276
Practice Address - Fax:207-934-0465
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28697207R00000X
MEMD19743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004760OtherKAISER-COMMERCIAL NUMBER
CO75350882Medicaid
COCK10568Medicare PIN
004760OtherKAISER-COMMERCIAL NUMBER
CO75350882Medicaid