Provider Demographics
NPI:1003826140
Name:MADAN, VINAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:
Last Name:MADAN
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 1:35 DANBURY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4444
Mailing Address - Country:US
Mailing Address - Phone:203-762-6365
Mailing Address - Fax:203-762-6367
Practice Address - Street 1:35 DANBURY RD STE 9
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4444
Practice Address - Country:US
Practice Address - Phone:203-762-6365
Practice Address - Fax:203-763-6367
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40375202K00000X, 2085R0204X
CT0403752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1403758Medicaid
CTP01395182OtherMEDICARE RAILROAD PTAN
CTD400129217Medicare PIN
CT300003247Medicare UPIN
CT1403758Medicaid