Individual
IAN MADOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 HIGH ST, WAKEFIELD, RI 02879
(401) 789-1422
(401) 782-6810
Mailing address
1 HIGH ST, WAKEFIELD, RI 02879-3103
(401) 789-1422
(401) 782-6810
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
LP00165
RI
207X00000X
Orthopaedic Surgery Physician
Primary
MD12744
RI
207XS0117X
Orthopaedic Surgery of the Spine Physician
256162
NY
207XX0801X
Orthopaedic Trauma Physician
256162
NY
Other
Enumeration date
04/20/2007
Last updated
05/22/2018
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