MEDICARE: DR. JASON PALMER MADER D.O.

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	207RC0000X	Cardiovascular Disease Physician	3229	WV
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	3229	WV

General Provider Information

NPI Number	:	1508132960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON PALMER MADER D.O.

Provider Business Mailing Address
First Line	:	3110 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1210
Country	:	US
Telephone Number	:	304-388-6355
Fax Number	:	304-388-6009

Provider Business Practice Location Address
First Line	:	1249 15TH ST STE 4000
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3663
Country	:	US
Telephone Number	:	304-691-8500
Fax Number	:	304-691-8510

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	06/01/2026

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