Active NPI
Serafino S Maducdoc, MD
- Family Medicine Physician
- Oak Hill, WV
National Provider Identifier
1376569137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11029
- Practice address
- 320 Jones Avenue
Oak Hill, WV 25901 - Phone
- (304) 469-2500
- Fax
- (304) 469-3399
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11029 | WV | Primary |
Addresses
Primary practice location
320 Jones Avenue
Oak Hill, WV 25901
Mailing address
330 Franklin Road, #135a-138
Brentwood, TN 37027
Phone (615) 309-3300
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000474237 | Other | WV | MOUNTAIN BCBS |
| 0127602000 | Medicaid | WV | |
| 450931 | Other | WV | CARELINK |
| 010357861 | Medicaid | VA | |
| 0239610 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11029 | WV | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216598400000",
"number": "1376569137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 FRANKLIN ROAD, #135A-138",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "37027",
"telephone_number": "615-309-3300",
"fax_number": "615-309-3339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 JONES AVENUE",
"city": "OAK HILL",
"state": "WV",
"postal_code": "25901",
"telephone_number": "304-469-2500",
"fax_number": "304-469-3399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADUCDOC",
"first_name": "SERAFINO",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2008-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "11029",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOUNTAIN BCBS",
"identifier": "000474237",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0127602000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARELINK",
"identifier": "450931",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010357861",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0239610",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Hill, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.