Provider Demographics
NPI:1578524211
Name:MADEIRA, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:MADEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2905 EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5409
Mailing Address - Country:US
Mailing Address - Phone:610-770-9569
Mailing Address - Fax:610-770-9569
Practice Address - Street 1:2905 EDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5409
Practice Address - Country:US
Practice Address - Phone:610-770-9569
Practice Address - Fax:610-770-9569
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD072382L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001882935Medicaid
PA048340Medicare ID - Type Unspecified
PA001882935Medicaid