Healthcare Provider Details

I. General information

NPI: 1689042293
Provider Name (Legal Business Name): MADISON MARGARET DANNER MS, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 S 43RD ST
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

773 S 43RD ST
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 609-774-4107
  • Fax:
Mailing address:
  • Phone: 609-774-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: