Provider Demographics
NPI:1639156151
Name:MADERAZO, EUFRONIO G (MD)
Entity Type:Individual
Prefix:
First Name:EUFRONIO
Middle Name:G
Last Name:MADERAZO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 WASHINGTON ST
Mailing Address - Street 2:EASTERN CT HEMATOLOGY & ONCOLOGY SUITE 220
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-886-8362
Mailing Address - Fax:860-886-9262
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:EASTERN CT HEMATOLOGY & ONCOLOGY SUITE 220
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-8362
Practice Address - Fax:860-886-9262
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT016782207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5816OtherHEALTHNET
CT010016782CT03OtherBCBS
E43457Medicare UPIN