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General NPI Number Information
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NPI Number | 1861805921
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Entity Type | Individual
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Provider Name | OLIVIA PENN MADAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 1914 CHARLOTTE AVE STE 101
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City | NASHVILLE
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State | TN
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Zip | 37203-2231
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Country | US
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Telephone | 615-327-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 905 S HAWTHORNE RD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4416
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Country | US
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Telephone | 864-650-6228
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 60988
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License Number State | TN
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