Provider Demographics
NPI:1831214527
Name:EWING, MADELEINE QUAIL (MD)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:QUAIL
Last Name:EWING
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 1:700 SPRUCE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4023
Mailing Address - Country:US
Mailing Address - Phone:215-829-6802
Mailing Address - Fax:215-829-6807
Practice Address - Street 1:700 SPRUCE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4023
Practice Address - Country:US
Practice Address - Phone:215-829-6802
Practice Address - Fax:215-829-6807
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAMD015546E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
31334OtherAETNA
PA0650275Medicaid
835701OtherHEALTH PASS
EW132512OtherBLUE CROSS BLUE SHIELD
PAC31193Medicare ID - Type Unspecified
PA0650275Medicaid