Individual
MADHAVI BHOOMAGOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
455 LEWIS AVE, SUITE 105, MERIDEN, CT 06451-2121
(203) 237-2477
(203) 238-1839
Mailing address
455 LEWIS AVE, SUITE 105, MERIDEN, CT 06451-2121
(203) 237-2477
(203) 238-1839
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
047262
CT
207RG0100X
Gastroenterology Physician
Primary
047262
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047262
LICENSE
CT
Enumeration date
06/18/2009
Last updated
07/02/2014
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