Provider Demographics
NPI:1083720957
Name:MADDEN, M ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:ANGELA
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 1:1700 NE 26TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1430
Mailing Address - Country:US
Mailing Address - Phone:954-563-3158
Mailing Address - Fax:954-563-5874
Practice Address - Street 1:1700 NE 26TH ST STE 4
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1430
Practice Address - Country:US
Practice Address - Phone:954-563-3158
Practice Address - Fax:954-563-5874
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51661XOtherMEDICARE PTAN
FL0007432187OtherUNITED HEALTH CARE
FLCK2070OtherRAILROAD MEDICARE
FL51661OtherBCBS OF FLORIDA
FL0463133OtherAETNA
FL034933OtherNEIGHBORHOOD
FL181480423086OtherHUMANA
FL51661OtherBCBS OF FLORIDA