Provider Demographics
NPI:1326074998
Name:MADDEN, VIKTORIA (PA)
Entity Type:Individual
Prefix:MS
First Name:VIKTORIA
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VIKTORIYA
Other - Middle Name:
Other - Last Name:AVADVAYEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:VALLEY MEDICAL ASSOCIATES SUITE 207
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-0669
Mailing Address - Fax:413-739-0621
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:VALLEY MEDICAL ASSOCIATES SUITE 207
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-0669
Practice Address - Fax:413-739-0621
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2124363AM0700X
CT000718363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400245962Medicare PIN
MAAP2659Medicare PIN