Provider Demographics
NPI:1982609772
Name:MADEIRA, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MADEIRA
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 1:407 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5526
Mailing Address - Country:US
Mailing Address - Phone:215-860-3344
Mailing Address - Fax:215-860-8950
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:STE 317
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:609-585-2040
Practice Address - Fax:609-585-2520
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04066300207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1135374OtherHORIZON NJ HEALTH #
NJ4096750OtherAETNA PPO #
NJ0075258000OtherAMERIHEALTH #
NJ82996OtherAMERIGROUP #
NJ4973101Medicaid
NJMES266OtherOXFORD ID #
NJ1K0311OtherHEALTHNET #
NJ35109OtherAETNA HMO #
NJMES266OtherOXFORD ID #
NJ1135374OtherHORIZON NJ HEALTH #