Provider Demographics
NPI:1609107531
Name:DR. JENNIFER MADDEN'S FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:DR. JENNIFER MADDEN'S FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-769-3308
Mailing Address - Street 1:1 PHOENIX MILL LN UNIT 200
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1445
Mailing Address - Country:US
Mailing Address - Phone:603-924-7797
Mailing Address - Fax:603-822-2813
Practice Address - Street 1:3 NORTHERN BLVD STE A3
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2329
Practice Address - Country:US
Practice Address - Phone:603-769-3308
Practice Address - Fax:603-769-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0014783Medicare PIN