Provider Demographics
NPI:1619736709
Name:MADDOX, VICTORIA MARIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIA
Last Name:MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4901
Mailing Address - Country:US
Mailing Address - Phone:540-212-0619
Mailing Address - Fax:
Practice Address - Street 1:604 MELLON ST SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2538
Practice Address - Country:US
Practice Address - Phone:240-863-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant