Provider Demographics
NPI:1790474039
Name:MADAN, ARCHIE
Entity Type:Individual
Prefix:
First Name:ARCHIE
Middle Name:
Last Name:MADAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EAST ONE MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:CROZER CHESTER MEDICAL CENTER
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-447-6370
Mailing Address - Fax:610-447-6373
Practice Address - Street 1:3 EAST ONE MEDICAL CENTER BOULEVARD
Practice Address - Street 2:CROZER CHESTER MEDICAL CENTER
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-447-6370
Practice Address - Fax:610-447-6373
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program