Provider Demographics
NPI:1790246023
Name:ANDERSON, MADISON SHIRKEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:SHIRKEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:MADISON
Other - Last Name:SHIRKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5170 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2004
Mailing Address - Country:US
Mailing Address - Phone:304-399-4422
Mailing Address - Fax:304-399-4433
Practice Address - Street 1:5170 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2004
Practice Address - Country:US
Practice Address - Phone:304-399-4422
Practice Address - Fax:304-399-4433
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics