Healthcare Provider Details

I. General information

NPI: 1285176784
Provider Name (Legal Business Name): AMELIA MADARAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT STREET 5TH FLOOR ROTHMAN INSTITUTE
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

250 INDIAN LN
BOYERTOWN PA
19512-8644
US

V. Phone/Fax

Practice location:
  • Phone: 610-755-3098
  • Fax: 610-495-1587
Mailing address:
  • Phone: 484-366-7203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN574409
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: