Provider Demographics
NPI:1962243014
Name:MADDOX, MARK DAVIS
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVIS
Last Name:MADDOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-2320
Mailing Address - Country:US
Mailing Address - Phone:513-400-9681
Mailing Address - Fax:
Practice Address - Street 1:513 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-2320
Practice Address - Country:US
Practice Address - Phone:513-400-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide