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Individual

DR. SURESH MANDAVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2046 W MAIN ST STE 2, STAMFORD, CT 06902-4523
(203) 869-3082
(203) 869-6453
Mailing address
2046 W MAIN ST STE 2, STAMFORD, CT 06902-4523
(203) 869-3082
(203) 869-6453

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036932
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010036932CT01
ANTHEM BCBS
01
036932
CONNECTICARE
01
2046779
AETNA
01
2V8862
HEALTHNET
01
9Y214
EMPIRE
Enumeration date
07/11/2005
Last updated
03/27/2018
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