Healthcare Provider Details

I. General information

NPI: 1710668587
Provider Name (Legal Business Name): MADISON LEIGH CHADWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HICKORY SQUARE RD
DAWSON PA
15428-1128
US

IV. Provider business mailing address

145 HICKORY SQUARE RD
DAWSON PA
15428-1128
US

V. Phone/Fax

Practice location:
  • Phone: 304-972-6686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066767
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: