Provider Demographics
NPI:1609890524
Name:MADDER, ROBERT D (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:MADDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1957
Mailing Address - Country:US
Mailing Address - Phone:724-728-8751
Mailing Address - Fax:724-728-4633
Practice Address - Street 1:500 SHARON RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1957
Practice Address - Country:US
Practice Address - Phone:724-728-8751
Practice Address - Fax:724-728-4633
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003758L207R00000X
OH34005187M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017551460001Medicaid
PA153786LCKMedicare PIN
B40057Medicare UPIN