Healthcare Provider Details

I. General information

NPI: 1962701417
Provider Name (Legal Business Name): MADISON PADDOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW DEPT OF MEDICINE
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

505 PARNASSUS AVE DEPT OF MEDICINE
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8168
  • Fax: 877-303-1460
Mailing address:
  • Phone: 415-476-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: