Provider Demographics
NPI:1104856921
Name:GOWDA, MADHU SIDDAVEERE (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:SIDDAVEERE
Last Name:GOWDA
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 1:63 FARM HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2335
Mailing Address - Country:US
Mailing Address - Phone:203-888-9340
Mailing Address - Fax:203-888-9649
Practice Address - Street 1:17 WESTERMAN AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3320
Practice Address - Country:US
Practice Address - Phone:203-888-9340
Practice Address - Fax:203-888-9649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034989207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01349895Medicaid
CT01349895Medicaid
110008027Medicare ID - Type Unspecified