Provider Demographics
NPI:1790731768
Name:MADHOUN, MAHER I (MD)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:I
Last Name:MADHOUN
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:ONE HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3628
Mailing Address - Country:US
Mailing Address - Phone:203-276-7298
Mailing Address - Fax:203-276-4842
Practice Address - Street 1:ONE HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3628
Practice Address - Country:US
Practice Address - Phone:203-276-7298
Practice Address - Fax:203-276-4842
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044253207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I54913Medicare UPIN
CT110009934Medicare PIN
CT2500113OtherCIGNA
CT1278464OtherAETNA
CTP00395617Medicare PIN
I54913Medicare UPIN