Provider Demographics
NPI:1285740373
Name:MADARANG, ERNESTO D (MD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:D
Last Name:MADARANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5662
Mailing Address - Country:US
Mailing Address - Phone:509-586-0745
Mailing Address - Fax:
Practice Address - Street 1:919 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5662
Practice Address - Country:US
Practice Address - Phone:509-586-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1074806Medicaid
WA1074806Medicaid
WAD33928Medicare UPIN