Provider Demographics
NPI:1881719094
Name:MADELL, SETH D (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:D
Last Name:MADELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 S. WATER ST.
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1208
Mailing Address - Country:US
Mailing Address - Phone:505-526-5924
Mailing Address - Fax:505-526-5942
Practice Address - Street 1:142 S WATER ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1208
Practice Address - Country:US
Practice Address - Phone:505-526-5924
Practice Address - Fax:505-526-5942
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-289208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice