Healthcare Provider Details

I. General information

NPI: 1679556385
Provider Name (Legal Business Name): PATRICK E. MADDEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DRIVE SUITE 406
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

354 BIRNIE AVE
SPRINGFIELD MA
01107-1108
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-4242
  • Fax: 413-733-1047
Mailing address:
  • Phone: 413-733-3470
  • Fax: 413-733-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000722
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2208
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: