Provider Demographics
NPI:1912909201
Name:DAVIDOFF, MADALYN N (MD)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:N
Last Name:DAVIDOFF
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 1:1570 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3432
Mailing Address - Country:US
Mailing Address - Phone:478-929-5997
Mailing Address - Fax:478-929-9411
Practice Address - Street 1:1570 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3432
Practice Address - Country:US
Practice Address - Phone:478-929-5997
Practice Address - Fax:478-929-9411
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042561207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH42995Medicare UPIN
GA06BDHZVMedicare PIN