Provider Demographics
NPI:1275229403
Name:WATLINGTON, MADALYN BEYER (MD)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:BEYER
Last Name:WATLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CONSTANTIN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3489
Mailing Address - Country:US
Mailing Address - Phone:225-374-1317
Mailing Address - Fax:225-374-1611
Practice Address - Street 1:8415 GOODWOOD BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-765-8013
Practice Address - Fax:225-765-2033
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program