Healthcare Provider Details

I. General information

NPI: 1891969937
Provider Name (Legal Business Name): RAMANATHAN MADRAS SESHADRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

IV. Provider business mailing address

24 STEVENS ST
NORWALK CT
06850-3852
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7000
  • Fax:
Mailing address:
  • Phone: 203-845-4811
  • Fax: 203-899-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2013-00912
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number66791
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: