Individual
MADISON VANSAVAGE MABEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
433 NETWORK STA, CHESAPEAKE, VA 23320
(757) 892-5300
(757) 892-5303
Mailing address
433 NETWORK STA, CHESAPEAKE, VA 23320-3851
(757) 892-5300
(757) 892-5303
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CO005977
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009190414
—
VA
05
—
09190414
—
VA
Enumeration date
11/05/2018
Last updated
05/30/2019
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