Provider Demographics
NPI:1023031655
Name:CHOW, MADELINE TAM (NP)
Entity Type:Individual
Prefix:MISS
First Name:MADELINE
Middle Name:TAM
Last Name:CHOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1510 4TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1717
Mailing Address - Country:US
Mailing Address - Phone:510-525-8980
Mailing Address - Fax:510-525-8982
Practice Address - Street 1:1510 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1717
Practice Address - Country:US
Practice Address - Phone:510-525-8980
Practice Address - Fax:510-525-8982
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10811363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0108110Medicaid
CANP0108110Medicaid
CAP60439Medicare UPIN
CAZZZ29943ZMedicare PIN
CANP0108110Medicaid