Healthcare Provider Details

I. General information

NPI: 1578871703
Provider Name (Legal Business Name): MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WESTFIELD AVE
ANSONIA CT
06401-1158
US

IV. Provider business mailing address

63 FARM HILL RD
ORANGE CT
06477-2335
US

V. Phone/Fax

Practice location:
  • Phone: 203-888-9340
  • Fax: 203-888-9649
Mailing address:
  • Phone: 203-888-9340
  • Fax: 203-888-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number034989
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number034989
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number034989
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number034989
License Number StateCT

VIII. Authorized Official

Name: DR. MADHU SIDDAVEERE GOWDA
Title or Position: SINGLE MEMBER PROVIDER
Credential: M. D.
Phone: 203-888-9340