Provider Demographics
NPI:1154868628
Name:GWINN, MADELEINE CARROLL (DO)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:CARROLL
Last Name:GWINN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:319 DOUBLE EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-8190
Mailing Address - Country:US
Mailing Address - Phone:304-646-2212
Mailing Address - Fax:
Practice Address - Street 1:527 MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9010
Practice Address - Country:US
Practice Address - Phone:681-342-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program