Provider Demographics
NPI:1699765743
Name:MADDEN, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MADDEN
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0366
Mailing Address - Country:US
Mailing Address - Phone:413-733-0010
Mailing Address - Fax:413-930-2108
Practice Address - Street 1:134 CAPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1349
Practice Address - Country:US
Practice Address - Phone:413-747-1817
Practice Address - Fax:413-747-6120
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75716204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3093832Medicaid
CT003087881Medicaid
MAJ12335Medicare PIN
CT020001323Medicare PIN
CT003087881Medicaid
020031481Medicare PIN
CT020001323Medicare PIN
CT003087881Medicaid
020031481Medicare PIN