Provider Demographics
NPI:1578871703
Name:MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:SIDDAVEERE
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:203-888-9340
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 1:22 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1158
Practice Address - Country:US
Practice Address - Phone:203-888-9340
Practice Address - Fax:203-888-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034989207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001349895Medicaid
110008027OtherMEDICARE PROVIDER NUMBER FOR MADHU GOWDA WHO IS A SINGLE MEMBER OF THIS LLC
G21196Medicare UPIN