Healthcare Provider Details

I. General information

NPI: 1760349542
Provider Name (Legal Business Name): MADISON FEESER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S COLLEGE AVE
NEWARK DE
19716-2000
US

IV. Provider business mailing address

105 RUPPERT RD
EAST BERLIN PA
17316-9181
US

V. Phone/Fax

Practice location:
  • Phone: 717-409-2766
  • Fax:
Mailing address:
  • Phone: 717-409-2766
  • Fax: 717-409-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ3-0010945
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: