Provider Demographics
NPI:1093466542
Name:DURAN MEDINA, MADELINE ABIGAIL
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ABIGAIL
Last Name:DURAN MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34150 HARRY BYRD HWY
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-2105
Mailing Address - Country:US
Mailing Address - Phone:571-465-8520
Mailing Address - Fax:
Practice Address - Street 1:34150 HARRY BYRD HWY
Practice Address - Street 2:
Practice Address - City:ROUND HILL
Practice Address - State:VA
Practice Address - Zip Code:20141-2105
Practice Address - Country:US
Practice Address - Phone:571-465-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician