Individual
AMANDA MADKOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
51-53 KENOSIA AVE, DANBURY, CT 06810-2304
(203) 748-0330
Mailing address
51-53 KENOSIA AVE, DANBURY, CT 06810-2304
(203) 748-0330
(203) 797-0255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
001399
CT
208800000X
Urology Physician
52744
CT
363A00000X
Physician Assistant
Primary
52744
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139900
CONNECTCARE
CT
01
—
290001399CT01
ANTHEM BC/BS
CT
01
—
P3188856
OXFORD
CT
Enumeration date
02/02/2006
Last updated
01/15/2021
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