Provider Demographics
NPI:1114514361
Name:TYSON, MADALINE P
Entity Type:Individual
Prefix:
First Name:MADALINE
Middle Name:P
Last Name:TYSON
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 1:1 ROSS PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2671
Mailing Address - Country:US
Mailing Address - Phone:419-603-1554
Mailing Address - Fax:740-264-2422
Practice Address - Street 1:1 ROSS PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2671
Practice Address - Country:US
Practice Address - Phone:740-264-7751
Practice Address - Fax:740-264-2422
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No156F00000XEye and Vision Services ProvidersTechnician/Technologist