Healthcare Provider Details

I. General information

NPI: 1275529760
Provider Name (Legal Business Name): JAN W MADISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 COUNTRY CLUB RD FL 4
MONONGAHELA PA
15063-1013
US

IV. Provider business mailing address

1163 COUNTRY CLUB RD
MONONGAHELA PA
15063-1013
US

V. Phone/Fax

Practice location:
  • Phone: 724-797-9550
  • Fax: 888-720-4544
Mailing address:
  • Phone: 724-797-9550
  • Fax: 888-720-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD043801E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: