Provider Demographics
NPI:1750476271
Name:MADIA, ELIZABETH M (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:MADIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 JACKSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST BROWNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417
Mailing Address - Country:US
Mailing Address - Phone:724-322-3294
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:WHEELING HOSPITAL INC
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMAPA79211Medicare ID - Type Unspecified
WVQ68405Medicare UPIN