Healthcare Provider Details

I. General information

NPI: 1821225368
Provider Name (Legal Business Name): TIMOTHY MADDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PINE GROVE AVE
KINGSTON NY
12401-5407
US

IV. Provider business mailing address

45 PINE GROVE AVE
KINGSTON NY
12401-5407
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4500
  • Fax: 845-340-4501
Mailing address:
  • Phone: 845-340-4500
  • Fax: 845-340-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number279192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: