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General NPI Number Information
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NPI Number | 1235142100
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Entity Type | Individual
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Provider Name | MADHU MATHUR MD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 2777 SUMMER ST STE 604
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City | STAMFORD
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State | CT
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Zip | 06905-4318
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Country | US
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Telephone | 203-614-8517
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Fax | 203-614-8518
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Provider Business Mailing Address
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Address Line | 108 GLENVILLE RD
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City | GREENWICH
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State | CT
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Zip | 06831-4434
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Country | US
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Telephone | 203-550-6085
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 039624
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 221166
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 039624
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 221166
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License Number State | NY
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