Healthcare Provider Details

I. General information

NPI: 1235142100
Provider Name (Legal Business Name): MADHU MATHUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 SUMMER ST STE 604
STAMFORD CT
06905-4318
US

IV. Provider business mailing address

108 GLENVILLE RD
GREENWICH CT
06831-4434
US

V. Phone/Fax

Practice location:
  • Phone: 203-614-8517
  • Fax: 203-614-8518
Mailing address:
  • Phone: 203-550-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number039624
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number221166
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number039624
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number221166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: