Provider Demographics
NPI:1801117122
Name:MADISON, ASENA L (MD)
Entity type:Individual
Prefix:DR
First Name:ASENA
Middle Name:L
Last Name:MADISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9549 AMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1256
Mailing Address - Country:US
Mailing Address - Phone:804-362-7372
Mailing Address - Fax:866-834-5648
Practice Address - Street 1:9549 AMBERDALE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1256
Practice Address - Country:US
Practice Address - Phone:804-362-7372
Practice Address - Fax:866-834-5648
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116022450207Q00000X
VA0101251657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI723OtherGROUP PTAN
VA1801117122Medicaid
VA1972654929Medicaid
VA1548732936OtherGROUP NPI