Individual
BIRRILLA MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1850 STATE ST, NEW ALBANY, IN 47150-4990
(812) 944-7701
(812) 981-6505
Mailing address
350 HOSPITAL WAY, SUITE 101, SOMERSET, KY 42503-2872
(606) 451-5092
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02005072A
IN
207R00000X
Internal Medicine Physician
04002
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100512760
—
KY
Enumeration date
06/09/2014
Last updated
07/23/2024
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