Individual
JEFFREY W. MADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
527 MEDICAL PARK DR, SUITE 202, BRIDGEPORT, WV 26330-9007
(304) 933-3850
(304) 933-3859
Mailing address
527 MEDICAL PARK DR, SUITE 202, BRIDGEPORT, WV 26330-9009
(304) 933-3855
(304) 933-3859
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20432
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721899
BLUE CROSS PROVIDER NUMBE
WA
05
—
2002872000
—
WV
01
—
550748648
TAX IDENTIFICATION
WV
Enumeration date
06/26/2006
Last updated
04/05/2022
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