Provider Demographics
NPI:1538278338
Name:MENON, MADHAVI (MD)
Entity type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 TOWPATH RD STE 155
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9581
Mailing Address - Country:US
Mailing Address - Phone:315-701-0070
Mailing Address - Fax:315-701-0075
Practice Address - Street 1:6711 TOWPATH RD STE 155
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9581
Practice Address - Country:US
Practice Address - Phone:315-701-0070
Practice Address - Fax:315-701-0075
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203325207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology