Provider Demographics
NPI:1235142100
Name:MATHUR, MADHU (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:
Last Name:MATHUR
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 1:108 GLENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-4434
Mailing Address - Country:US
Mailing Address - Phone:203-550-6085
Mailing Address - Fax:
Practice Address - Street 1:2777 SUMMER ST
Practice Address - Street 2:STE 604
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4318
Practice Address - Country:US
Practice Address - Phone:203-614-8517
Practice Address - Fax:203-614-8518
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039624208000000X, 2083B0002X
NY2211662083B0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2079769OtherFIRST HEALTH / CCN
CT797586OtherCONNECTICARE
TINOtherFOCUS
TINOtherCONSUMER HEALTH NETWORK
CT2215002OtherUNITED HEALTHCARE
TINOtherWELLCARE/ FIRST CHOICE
CT5129667OtherCIGNA
TINOtherMULTIPLAN
CT010039624CT01OtherANTHEM BC/BS
CT507X21OtherEMPIRE BC/BS
TINOtherPOMCO
CT2V4390OtherHEALTH NET
CT7916409OtherAETNA
CTP2645508OtherOXFORD HEALTH PLAN
TINOtherPRIVATE HEALTHCARE SYSTEM
TINOtherWELLCARE/ FIRST CHOICE