Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | LP00165 | RI |
Y | 207X00000X | Orthopaedic Surgeon | MD12744 | RI |
N | 207XS0117X | Orthopaedic Spine Surgeon | 256162 | NY |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 256162 | NY |
NPI | 1194942078 |
---|---|
Provider Name | Ian Madom |
First Address | Wakefield, RI 02879-3103 |
Second Address | Wakefield, RI 02879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 22/05/2018 |