| Doctor Name: | DR. IRVIN R MADURO |
| NPI Number: | 1417018946 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD22166 |
| Business Practice Address: | 6014 Old Branch Ave Kaiser Permanente Camp Springs Medical Center Temple Hills, MD - 207482518 |
| Business Phone Number: | 3017026100 |
| Business Fax Number: | 3017026366 |
| Mailing Address: | 2101 E Jefferson St Ppqa Medicare Compliance Unit 6 W, Kaiser Permanente Mid Atlantic Permanente Medical Group ROCKVILLE |
| State: | MD |
| Postal Code: | 208524908 |
| Phone Number: | 3018166660 |
| Fax Number: | 3018166308 |
| NPI Enumeration Date: | 12/12/2006 |
| NPI Last Update Date: | 12/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WP0200X |
| License Number: | MD22166 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DC |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | Optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children. |