Provider Demographics
NPI:1831178615
Name:MADNICK, MARNI B (MD)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:B
Last Name:MADNICK
Suffix:
Gender:F
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 2190
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-2190
Mailing Address - Country:US
Mailing Address - Phone:603-356-9355
Mailing Address - Fax:603-356-8843
Practice Address - Street 1:2977 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5111
Practice Address - Country:US
Practice Address - Phone:603-356-9355
Practice Address - Fax:603-356-8843
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH11924207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203629Medicaid
NH30203629Medicaid
H87656Medicare UPIN