Healthcare Provider Details

I. General information

NPI: 1548220197
Provider Name (Legal Business Name): SARAH D. MADDISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL SUITE 300
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

1304 DIEHL ST
RALEIGH NC
27608-2110
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5510
  • Fax: 919-781-5053
Mailing address:
  • Phone: 919-781-5510
  • Fax: 919-781-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number200200950
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: