Provider Demographics
NPI:1164496188
Name:MADONIA, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:MADONIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WESCOTT DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4677
Mailing Address - Country:US
Mailing Address - Phone:908-237-6910
Mailing Address - Fax:908-237-6919
Practice Address - Street 1:9100 WESCOTT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4677
Practice Address - Country:US
Practice Address - Phone:908-237-6910
Practice Address - Fax:908-237-6919
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02650200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0590304Medicaid
NJMA130021Medicare ID - Type Unspecified
NJC53433Medicare UPIN