Healthcare Provider Details

I. General information

NPI: 1295411759
Provider Name (Legal Business Name): MADISON REEPING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON DERUBBO PA-C

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HOSPITAL AVE GROUND FLOOR
DU BOIS PA
15801-1409
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-503-4433
  • Fax:
Mailing address:
  • Phone: 814-375-4200
  • Fax: 814-375-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064614
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA064614
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: