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General NPI Number Information
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NPI Number | 1295371458
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Entity Type | Individual
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Provider Name | MADISON E GOUDY PA-C, MSPAS
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 875 AAA BLVD STE C
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City | NEWARK
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State | DE
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Zip | 19713-3624
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Country | US
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Telephone | 302-918-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 8 WILTON WAY
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-9212
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Country | US
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Telephone | 610-741-4259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C5-0001372
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License Number State | DE
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