Provider Demographics
NPI:1720048960
Name:MADDEN, JILL L (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:MADDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 QUINCE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3214
Mailing Address - Country:US
Mailing Address - Phone:814-931-5815
Mailing Address - Fax:814-224-2246
Practice Address - Street 1:2230 WOODBURY PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16659-9506
Practice Address - Country:US
Practice Address - Phone:814-766-3485
Practice Address - Fax:814-766-2379
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA050983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075939Medicare PIN
PAQ05241Medicare UPIN