Provider Demographics
NPI:1003016957
Name:MATHUR, SHISHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHISHIR
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SYCAMORE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-7208
Mailing Address - Country:US
Mailing Address - Phone:860-633-0500
Mailing Address - Fax:860-633-5250
Practice Address - Street 1:27 SYCAMORE ST STE 400
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-7208
Practice Address - Country:US
Practice Address - Phone:860-633-0500
Practice Address - Fax:860-633-5250
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047888207RI0011X, 207RC0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1003016957Medicaid