Provider Demographics
NPI:1265464903
Name:MADDEN, REGINALD LEVON (DNP)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:LEVON
Last Name:MADDEN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 BLUE RIDGE RD STE 550
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6476
Mailing Address - Country:US
Mailing Address - Phone:919-787-5380
Mailing Address - Fax:919-787-3415
Practice Address - Street 1:2800 BLUE RIDGE RD STE 550
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6476
Practice Address - Country:US
Practice Address - Phone:919-787-5380
Practice Address - Fax:919-787-3415
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5001551363LA2200X
NC159088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592681Medicare PIN