Provider Demographics
NPI:1093000309
Name:MADDEN, CAITLIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3319 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4226
Mailing Address - Country:US
Mailing Address - Phone:610-431-0200
Mailing Address - Fax:610-431-9333
Practice Address - Street 1:3319 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4226
Practice Address - Country:US
Practice Address - Phone:610-431-0200
Practice Address - Fax:610-431-9333
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01581213E00000X
PASC006296213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0950645 00Medicaid
DC430828YFCTMedicare PIN