Provider Demographics
NPI:1538643622
Name:JUSTICE, MADELYN (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9237 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21813-1321
Mailing Address - Country:US
Mailing Address - Phone:410-251-4831
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant