Provider Demographics
NPI:1194786822
Name:MADALIN, KARLA JEANNE (MD)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:JEANNE
Last Name:MADALIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6847 N CHESTNUT ST STE 325
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3929
Mailing Address - Country:US
Mailing Address - Phone:330-297-2401
Mailing Address - Fax:330-297-4485
Practice Address - Street 1:6847 N CHESTNUT ST STE 325
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-297-2401
Practice Address - Fax:330-297-4485
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350496372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0663334Medicare ID - Type Unspecified
E36641Medicare UPIN