Provider Demographics
NPI:1417018946
Name:MADURO, IRVIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVIN
Middle Name:R
Last Name:MADURO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Mailing Address - Street 2:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:6014 OLD BRANCH AVE
Practice Address - Street 2:KAISER PERMANENTE CAMP SPRINGS MEDICAL CENTER
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-2518
Practice Address - Country:US
Practice Address - Phone:301-702-6100
Practice Address - Fax:301-702-6366
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD22166152WP0200X
MDD0038713152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E33448Medicare UPIN
588433M92Medicare ID - Type Unspecified