Provider Demographics
NPI:1134674732
Name:KIDD, MADELINE CATHERINE (DO)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:CATHERINE
Last Name:KIDD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 HANCOCK ST.
Mailing Address - Street 2:APT 17
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:617-591-6097
Mailing Address - Fax:617-591-6435
Practice Address - Street 1:227 HANCOCK ST.
Practice Address - Street 2:APT 17
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:310-344-9288
Practice Address - Fax:617-591-6435
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-06-28
Deactivation Date:2022-04-20
Deactivation Code:
Reactivation Date:2022-06-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program