Provider Demographics
NPI:1033783733
Name:FLEMING, MADISON T
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:T
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KANAWHA AVE.
Mailing Address - Street 2:
Mailing Address - City:SMITHERS
Mailing Address - State:WV
Mailing Address - Zip Code:25186
Mailing Address - Country:US
Mailing Address - Phone:681-781-8913
Mailing Address - Fax:
Practice Address - Street 1:124 KANAWHA AVE.
Practice Address - Street 2:
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25186
Practice Address - Country:US
Practice Address - Phone:681-781-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant