Healthcare Provider Details

I. General information

NPI: 1376569137
Provider Name (Legal Business Name): SERAFINO S MADUCDOC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 JONES AVENUE
OAK HILL WV
25901
US

IV. Provider business mailing address

330 FRANKLIN ROAD, #135A-138
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-2500
  • Fax: 304-469-3399
Mailing address:
  • Phone: 615-309-3300
  • Fax: 615-309-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11029
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: