Healthcare Provider Details

I. General information

NPI: 1003826140
Provider Name (Legal Business Name): VINAY MADAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DANBURY RD STE 9
WILTON CT
06897-4444
US

IV. Provider business mailing address

35 DANBURY RD STE 9
WILTON CT
06897-4444
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-6365
  • Fax: 203-763-6367
Mailing address:
  • Phone: 203-762-6365
  • Fax: 203-762-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number40375
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number40375
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number040375
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: