MEDICARE: MRS. ROXANNE MADRID 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		MI

General Provider Information

NPI Number	:	1841182854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROXANNE MADRID PA-C

Provider Business Mailing Address
First Line	:	218 HOWLE AVE STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	313-591-2830
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 HOWLE AVE STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	313-591-2830
Fax Number	:

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

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	01/15/2026

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