Healthcare Provider Details

I. General information

NPI: 1750947065
Provider Name (Legal Business Name): MADISON MEDER-MCCAFFREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON MEDER MD

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

850 POPLAR AVE BLDG 2
MEMPHIS TN
38105-4607
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5674
  • Fax: 901-287-6804
Mailing address:
  • Phone: 901-287-5674
  • Fax: 901-287-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number69005
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: