Healthcare Provider Details

I. General information

NPI: 1447182159
Provider Name (Legal Business Name): MADISON PARTRIDGE JOACHIM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON PARTRIDGE FAGAN

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PLEASANT ST
BERLIN NH
03570-2006
US

IV. Provider business mailing address

133 PLEASANT ST
BERLIN NH
03570-2006
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-2040
  • Fax:
Mailing address:
  • Phone: 603-752-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3695
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: