Individual
MADISON E GOUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MSPAS
Contact information
Practice address
875 AAA BLVD STE C, NEWARK, DE 19713-3624
(302) 918-6400
Mailing address
8 WILTON WAY, SICKLERVILLE, NJ 08081-9212
(610) 741-4259
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C5-0001372
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C5-0001372
LICENSE NUMBER
DE
Enumeration date
11/22/2019
Last updated
11/22/2019
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