MEDICARE: RUTH MADDEN FOREMAN FNP

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	363LF0000X	Family Nurse Practitioner	F336598	NY
2	363LF0000X	Family Nurse Practitioner	0024169414	VA

General Provider Information

NPI Number	:	1790917912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH MADDEN FOREMAN FNP

Provider Business Mailing Address
First Line	:	5881 LEESBURG PIKE STE 400
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5881 LEESBURG PIKE STE 400
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2312
Country	:	US
Telephone Number	:	703-820-2866
Fax Number	:

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

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	03/31/2017

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