Provider Demographics
NPI:1669462859
Name:MADONIA, EUGENE CHARLES
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:CHARLES
Last Name:MADONIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLEVELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3700
Mailing Address - Country:US
Mailing Address - Phone:276-632-4181
Mailing Address - Fax:276-632-1559
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-632-4181
Practice Address - Fax:276-632-1559
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010316302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6188117Medicaid
VA6188117Medicaid
VA140000028Medicare ID - Type Unspecified