Provider Demographics
NPI:1194830505
Name:DICK, MADELINE ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:ANN
Last Name:DICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:ANN
Other - Last Name:DICK-BIASCOECHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1244 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4319
Mailing Address - Country:US
Mailing Address - Phone:203-785-6927
Mailing Address - Fax:203-785-2909
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 800
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042554207V00000X
PR014776207V00000X
MDD76973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT160002470Medicare PIN