Provider Demographics
NPI:1679590038
Name:PRATINIDHI, MADHURI (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHURI
Middle Name:
Last Name:PRATINIDHI
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 1:351 MERLINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4040
Mailing Address - Country:US
Mailing Address - Phone:860-871-1613
Mailing Address - Fax:860-875-8991
Practice Address - Street 1:351 MERLINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4040
Practice Address - Country:US
Practice Address - Phone:860-871-1613
Practice Address - Fax:860-875-8991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT035881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG83476Medicare UPIN