Provider Demographics
NPI:1871233965
Name:MADDEN, BARRA UNIQUE (MD)
Entity Type:Individual
Prefix:
First Name:BARRA
Middle Name:UNIQUE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 WESTCHESTER BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7117
Mailing Address - Country:US
Mailing Address - Phone:585-820-5292
Mailing Address - Fax:
Practice Address - Street 1:3643 N ROXBORO ST # 6
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2702
Practice Address - Country:US
Practice Address - Phone:919-684-8785
Practice Address - Fax:919-681-2290
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program