Healthcare Provider Details

I. General information

NPI: 1962461145
Provider Name (Legal Business Name): KEVIN G MADDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 JEFFERSON AVENUE
SCRANTON PA
18510
US

IV. Provider business mailing address

802 JEFFERSON AVENUE
SCRANTON PA
18510
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-1118
  • Fax: 570-348-1109
Mailing address:
  • Phone: 570-348-1118
  • Fax: 570-348-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD031073E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: