1235142100 NPI number — DR. MADHU MATHUR MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235142100 NPI number — DR. MADHU MATHUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHUR
Provider First Name:
MADHU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235142100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 GLENVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06831-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-550-6085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2777 SUMMER ST
Provider Second Line Business Practice Location Address:
STE 604
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-614-8517
Provider Business Practice Location Address Fax Number:
203-614-8518
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  039624 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083B0002X , with the licence number: 221166 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083B0002X , with the licence number: 039624 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 221166 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2079769 . This is a "FIRST HEALTH / CCN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 797586 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "FOCUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "CONSUMER HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2215002 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "WELLCARE/ FIRST CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5129667 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010039624CT01 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 507X21 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "POMCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V4390 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7916409 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2645508 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com