Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | MD466304 | PA |
Y | 207RP1001X | Pulmonary Disease | MD466304 | PA |
NPI | 1033552112 |
---|---|
Provider Name | Dr. John Charles Madara |
First Address | Willow Grove, PA 19090-1225 |
Second Address | Abington, PA 19001-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2013 |
Last Update Date | 22/11/2019 |