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General NPI Number Information
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NPI Number | 1518502442
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Entity Type | Individual
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Provider Name | MADELYN LEIGH CAVANAUGH AT
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Gender | Female
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 4501 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21210-2601
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Country | US
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Telephone | 240-315-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S WASHINGTON ST APT 1
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City | BALTIMORE
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State | MD
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Zip | 21231-2159
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Country | US
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Telephone | 317-764-0011
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1285
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0001546
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License Number State | MD
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