Provider Demographics
NPI:1851485239
Name:MADDEN, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:609 CHRISTOPHER DR
Practice Address - Street 2:PMG BELEN
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2615
Practice Address - Country:US
Practice Address - Phone:505-864-5454
Practice Address - Fax:505-864-5450
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM8182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25783Medicaid
NM25783Medicaid
NM25783Medicaid