1235142100 NPI number — DR. MADHU MATHUR MD

Table of content: DR. MADHU MATHUR MD (NPI 1235142100)

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".