Provider Demographics
NPI:1508165549
Name:MCFADDEN, MARTIN JOHN (CTRS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOHN
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 14H VA MARYLAND HEALTH CARE SYSTEM
Mailing Address - Street 2:RECREATION THERAPY SERVICE PP/117/RT
Mailing Address - City:PERRY POINT
Mailing Address - State:MD
Mailing Address - Zip Code:21902
Mailing Address - Country:US
Mailing Address - Phone:410-642-2411
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 14H VA MARYLAND HEALTH CARE SYSTEM
Practice Address - Street 2:RECREATION THERAPY SERVICE PP/117/RT
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD53078225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist