Provider Demographics
NPI:1497528558
Name:MADDEN PROFESSIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MADDEN PROFESSIONAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-541-7178
Mailing Address - Street 1:15502 HUMBERSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8046
Mailing Address - Country:US
Mailing Address - Phone:301-541-7178
Mailing Address - Fax:
Practice Address - Street 1:5505 1/2 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-4406
Practice Address - Country:US
Practice Address - Phone:301-541-7178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty