Healthcare Provider Details

I. General information

NPI: 1184680951
Provider Name (Legal Business Name): ROBERT K MADSEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 WISCONSIN AVE NW SUITE 303
WASHINGTON DC
20016-4118
US

IV. Provider business mailing address

5028 WISCONSIN AVE NW SUITE 303
WASHINGTON DC
20016-4118
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-2202
  • Fax: 202-686-2208
Mailing address:
  • Phone: 202-686-2202
  • Fax: 202-686-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01236
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: