Healthcare Provider Details

I. General information

NPI: 1437162880
Provider Name (Legal Business Name): JOSEPH PATRICK MADER AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 N FOUNTAIN BLVD
SPRINGFIELD OH
45501
US

IV. Provider business mailing address

PO BOX 632621
CINCINNATI OH
45263-2621
US

V. Phone/Fax

Practice location:
  • Phone: 937-390-5029
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax: 908-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number67000057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: