Provider Demographics
NPI:1194424721
Name:COFER, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:COFER
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 1:6852 CEDAR BROOK GLN
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9713
Mailing Address - Country:US
Mailing Address - Phone:614-551-0950
Mailing Address - Fax:
Practice Address - Street 1:40 ROWLAND AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2313
Practice Address - Country:US
Practice Address - Phone:614-551-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVA065702347C00000X
251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No347C00000XTransportation ServicesPrivate Vehicle