Provider Demographics
NPI:1336609593
Name:DECMAN, MADISON DARA (DO)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:DARA
Last Name:DECMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 BIRNIE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1109
Mailing Address - Country:US
Mailing Address - Phone:413-794-4744
Mailing Address - Fax:413-787-5273
Practice Address - Street 1:3455 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1187
Practice Address - Country:US
Practice Address - Phone:413-794-8484
Practice Address - Fax:413-794-8477
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1014972207V00000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program