Provider Demographics
NPI:1164413860
Name:FAY, MADELEINE R (MD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:R
Last Name:FAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FL ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:425 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2047
Practice Address - Country:US
Practice Address - Phone:508-595-2855
Practice Address - Fax:508-595-2602
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA48500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
9900106OtherFALLON COMMUNITY HEALTH
042472266OtherHEALTHCARE VALUE MANAGEME
3099407OtherWELFARE
3300063OtherEVERCARE
J04439OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
26807OtherCHILDRENS MEDICAL SECURIT
26807OtherHEALTHY START
J04439OtherBLUE CARE ELECT
1592180OtherCIGNA HEALTH PLAN
917696OtherFIRST HEALTH
5180602OtherAETNA US HEALTHCARE
784017OtherMVP HEALTH CARE
AA4451OtherHARVARD PILGRIM HEALTHCAR
J04439OtherBLUE SHIELD INDEMNITY
J04439OtherBLUE CARE ELECT
3300063OtherEVERCARE
917696OtherFIRST HEALTH
460002128Medicare ID - Type UnspecifiedRAILROAD