Healthcare Provider Details

I. General information

NPI: 1659753499
Provider Name (Legal Business Name): PARVATHY MADHAVAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CONNECTICUT BLVD
EAST HARTFORD CT
06108
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8085
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3245
  • Fax: 860-679-1217
Mailing address:
  • Phone: 860-679-3245
  • Fax: 860-679-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number064299
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: