Provider Demographics
NPI:1194915330
Name:MADRIGAL, VANESSA N (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:N
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 EAST PENN SQUARE
Mailing Address - Street 2:THE WANAMAKER BUILDING, 9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9300
Mailing Address - Fax:267-425-9331
Practice Address - Street 1:34TH STREET & CIVIC CENTER BLVD
Practice Address - Street 2:SUITE 9329
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-1858
Practice Address - Fax:215-590-3934
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2013-04-10
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Provider Licenses
StateLicense IDTaxonomies
PAMD4308032080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024895660001Medicaid
PA191470EMDOtherMEDICARE PTAN