Healthcare Provider Details

I. General information

NPI: 1013869718
Provider Name (Legal Business Name): MADISON LEE DUCKWORTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN STE 202
ALEXANDRIA VA
22310-3246
US

IV. Provider business mailing address

6355 WALKER LN STE 202
ALEXANDRIA VA
22310-3246
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-6464
  • Fax: 703-797-6981
Mailing address:
  • Phone: 310-529-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011661
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: