MEDICARE: DR. MARY MCFADEN CALDWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		VA

General Provider Information

NPI Number	:	1003956509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MCFADEN CALDWELL MD

Provider Business Mailing Address
First Line	:	1845 FOX DOWNS LN
Second Line	:
City	:	OILVILLE
State	:	VA
Zip	:	23129-2216
Country	:	US
Telephone Number	:	804-784-5987
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 CAPITAL ONE DR
Second Line	:	12078 HEALTH CENTER
City	:	RICHMOND
State	:	VA
Zip	:	23238-1119
Country	:	US
Telephone Number	:	804-855-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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