Provider Demographics
NPI:1063528784
Name:MADDEN, MATTHEW REMINGTON
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:REMINGTON
Last Name:MADDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4846
Mailing Address - Country:US
Mailing Address - Phone:561-310-8608
Mailing Address - Fax:
Practice Address - Street 1:4152 W BLUE HERON BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4811
Practice Address - Country:US
Practice Address - Phone:561-881-0040
Practice Address - Fax:561-863-6067
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00189332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies