Provider Demographics
NPI:1588824924
Name:MADALINE, THERESA FITZGERALD (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:FITZGERALD
Last Name:MADALINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLUMBIA UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:630 W 168TH STREET #4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:122-305-2500
Mailing Address - Fax:
Practice Address - Street 1:COLUMBIA UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:630 W 168TH STREET #4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:122-305-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255983207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty