Healthcare Provider Details

I. General information

NPI: 1154868628
Provider Name (Legal Business Name): MADELEINE GWINN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 S PIKE ST
SHINNSTON WV
26431-1043
US

IV. Provider business mailing address

686 S PIKE ST
SHINNSTON WV
26431-1043
US

V. Phone/Fax

Practice location:
  • Phone: 681-342-3800
  • Fax:
Mailing address:
  • Phone: 681-342-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4355
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: