Provider Demographics
NPI: | 1770686636 |
---|---|
Name: | MADSEN, JAMES MALCOLM (MD, MPH, FCAP, FACOE) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMES |
Middle Name: | MALCOLM |
Last Name: | MADSEN |
Suffix: | |
Gender: | M |
Credentials: | MD, MPH, FCAP, FACOE |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 527 INGLEWOOD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BEL AIR |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21015-2005 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-836-8754 |
Mailing Address - Fax: | 410-436-3086 |
Practice Address - Street 1: | 3100 RICKETTS POINT RD |
Practice Address - Street 2: | USAMRICD, ATTN: MCMR-CDM (COL MADSEN) |
Practice Address - City: | GUNPOWDER |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21010-5400 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-436-2230 |
Practice Address - Fax: | 410-436-3086 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-09-06 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 177428-1205 | 207ZP0102X, 2083X0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
Not Answered | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |