Provider Demographics
NPI:1093120610
Name:MENON, NANDINI RAVINDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:RAVINDRA
Last Name:MENON
Suffix:
Gender:F
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:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2828
Mailing Address - Country:US
Mailing Address - Phone:860-585-3773
Mailing Address - Fax:
Practice Address - Street 1:123 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5037
Practice Address - Country:US
Practice Address - Phone:860-584-8021
Practice Address - Fax:860-584-9021
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine