Healthcare Provider Details

I. General information

NPI: 1124187430
Provider Name (Legal Business Name): NALINI MENON PATHIYAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SILVER STREET CONNECTICUT VALLEY HOSPITAL
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

PO BOX 351 SILVER STREET CONNECTICUT VALLEY HOSPITAL
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-262-5867
  • Fax: 860-262-5850
Mailing address:
  • Phone: 860-262-5667
  • Fax: 860-262-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number026172
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: