=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013450956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADGE FLEURIMOND CEMELUS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2016
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 CONGRESS ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970-5590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-744-8388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 CONGRESS ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970-5590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-744-8388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9242
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9109719
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------