Healthcare Provider Details

I. General information

NPI: 1235699158
Provider Name (Legal Business Name): MADISON PAIGE TEDROW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MOUNTAIN ST
ASHEVILLE NC
28801-3827
US

IV. Provider business mailing address

116 MOUNTAIN ST
ASHEVILLE NC
28801-3827
US

V. Phone/Fax

Practice location:
  • Phone: 336-341-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08948
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: