Provider Demographics
NPI:1871758185
Name:MADDOCK, DAVID AUDOEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AUDOEN
Last Name:MADDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:297 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5720
Mailing Address - Country:US
Mailing Address - Phone:401-490-6464
Mailing Address - Fax:401-490-6463
Practice Address - Street 1:297 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-490-6464
Practice Address - Fax:401-490-6463
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13247207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology