Provider Demographics
NPI:1376569137
Name:MADUCDOC, SERAFINO S (MD)
Entity Type:Individual
Prefix:
First Name:SERAFINO
Middle Name:S
Last Name:MADUCDOC
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 1:330 FRANKLIN ROAD, #135A-138
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-309-3300
Mailing Address - Fax:615-309-3339
Practice Address - Street 1:320 JONES AVENUE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-2500
Practice Address - Fax:304-469-3399
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000474237OtherMOUNTAIN BCBS
WV0127602000Medicaid
WV450931OtherCARELINK
VA010357861Medicaid
OH0239610Medicaid
OH0239610Medicaid
WV0127602000Medicaid