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General NPI Number Information
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NPI Number | 1104856921
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Entity Type | Individual
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Provider Name | MADHU SIDDAVEERE GOWDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17 WESTERMAN AVE
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City | SEYMOUR
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State | CT
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Zip | 06483-3320
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Country | US
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Telephone | 203-888-9340
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Fax | 203-888-9649
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Provider Business Mailing Address
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Address Line | 63 FARM HILL RD
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City | ORANGE
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State | CT
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Zip | 06477-2335
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Country | US
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Telephone | 203-888-9340
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Fax | 203-888-9649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 034989
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License Number State | CT
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