Healthcare Provider Details

I. General information

NPI: 1295650166
Provider Name (Legal Business Name): MADELYN MARIE OLIVERI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

251 CAREFREE CT
HARDY VA
24101-3901
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3070
  • Fax:
Mailing address:
  • Phone: 540-272-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: