Basic Information
| Provider Information | |||||||||
| NPI: | 1326074998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | VIKTORIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AVADVAYEVA | ||||||||
| OtherFirstName: | VIKTORIYA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3640 MAIN ST | ||||||||
| Address2: | VALLEY MEDICAL ASSOCIATES SUITE 207 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137390669 | ||||||||
| FaxNumber: | 4137390621 | ||||||||
| Practice Location | |||||||||
| Address1: | 3640 MAIN ST | ||||||||
| Address2: | VALLEY MEDICAL ASSOCIATES SUITE 207 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137390669 | ||||||||
| FaxNumber: | 4137390621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 10/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2124 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 000718 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.