Provider Demographics
NPI:1760465652
Name:MADSEN, JOREN CHRISTIAN (MD DPHL)
Entity Type:Individual
Prefix:DR
First Name:JOREN
Middle Name:CHRISTIAN
Last Name:MADSEN
Suffix:
Gender:M
Credentials:MD DPHL
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-643-4808
Mailing Address - Fax:617-643-4582
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BUL 119
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1130
Practice Address - Fax:617-726-1821
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72269208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3108244Medicaid
MA072269OtherTUFTS HEALTH PLAN
MAJ13389OtherBCBS MA
MAJ13389OtherBCBS MA
MA072269OtherTUFTS HEALTH PLAN