Provider Demographics
NPI:1548515968
Name:M ANGELA MADDEN LLC
Entity type:Organization
Organization Name:M ANGELA MADDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-563-3158
Mailing Address - Street 1:1130 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2505
Mailing Address - Country:US
Mailing Address - Phone:954-563-3158
Mailing Address - Fax:954-563-5874
Practice Address - Street 1:1130 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2505
Practice Address - Country:US
Practice Address - Phone:954-563-3158
Practice Address - Fax:954-563-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51661OtherMEDICARE
FL0463133OtherAETNA
GACK2070OtherRAILROAD MEDICARE
FL0001185OtherAARP MEDICARE COMPLETE
F00219567801OtherNEIGHBORHOOD HEALTH
GACK2070OtherRAILROAD MEDICARE