Provider Demographics
NPI:1295705770
Name:MENON, SUNIL G (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:G
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 1:39 CARLETON ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3407
Mailing Address - Country:US
Mailing Address - Phone:203-865-5111
Mailing Address - Fax:203-562-2368
Practice Address - Street 1:1308 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4515
Practice Address - Country:US
Practice Address - Phone:203-865-5111
Practice Address - Fax:203-562-2368
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT036245OtherSTATE LICENSE NUMBER
CT110006869Medicare ID - Type UnspecifiedPROVIDER NUMBER
CT036245OtherSTATE LICENSE NUMBER