Provider Demographics
NPI:1104445964
Name:KAMP, MADELEINE HOPE (PA-C)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:HOPE
Last Name:KAMP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BROOKLINE AVE
Mailing Address - Street 2:MAYER 1B-23
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:203-722-4044
Mailing Address - Fax:
Practice Address - Street 1:167 LINDEN TREE RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-1617
Practice Address - Country:US
Practice Address - Phone:203-722-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant