MEDICARE: MADISON LEE DUCKWORTH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110011661	VA

General Provider Information

NPI Number	:	1013869718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LEE DUCKWORTH PA-C

Provider Business Mailing Address
First Line	:	221 6TH ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5735
Country	:	US
Telephone Number	:	310-529-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 N GLEBE RD STE 160
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-5758
Country	:	US
Telephone Number	:	571-472-6464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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