Provider Demographics
NPI:1659537439
Name:MENON, MADHAV C (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHAV
Middle Name:C
Last Name:MENON
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:PO BOX 208029
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8029
Mailing Address - Country:US
Mailing Address - Phone:203-785-7595
Mailing Address - Fax:
Practice Address - Street 1:YALE PHYSICIANS BUILDING
Practice Address - Street 2:800 HOWARD AVE, STE 4TH FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-737-1204
Practice Address - Fax:203-785-4184
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272162207RN0300X
390200000X
CT67045207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program