Individual
AYAZ T MADRASWALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
391 POMFRET ST, PUTNAM, CT 06260-1852
(860) 731-5522
Mailing address
2 WATERSIDE XING STE 401, WINDSOR, CT 06095-1588
(860) 731-5522
(860) 731-5522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34327
CT
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
034327
CT
Other
Enumeration date
08/25/2005
Last updated
01/22/2020
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