Provider Demographics
NPI:1104861665
Name:MADDEN, TESSA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:E
Last Name:MADDEN
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 1:310 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3218
Mailing Address - Country:US
Mailing Address - Phone:203-785-5545
Mailing Address - Fax:203-737-7675
Practice Address - Street 1:310 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-785-5545
Practice Address - Fax:888-315-6494
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT37426207VC0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204598304Medicaid
MO204598304Medicaid
MO324930217Medicaid