Provider Demographics
NPI:1851326011
Name:MADISON, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MADISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 CENTURY PLAZA RD
Mailing Address - Street 2:# 905
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5469
Mailing Address - Country:US
Mailing Address - Phone:317-279-6314
Mailing Address - Fax:317-947-2698
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:# 905
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5469
Practice Address - Country:US
Practice Address - Phone:317-279-6314
Practice Address - Fax:317-947-2698
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031866A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100326060AMedicaid
000000083157OtherBCBS PIN
760000004OtherRAILROAD MEDICARE PIN
000000083157OtherBCBS PIN
IN100326060AMedicaid