Provider Demographics
NPI:1801872528
Name:RAMADHAR PERSAUD, NIRMALA (MD)
Entity type:Individual
Prefix:
First Name:NIRMALA
Middle Name:
Last Name:RAMADHAR PERSAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIRMALA
Other - Middle Name:
Other - Last Name:RAMADAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4131
Mailing Address - Street 2:
Mailing Address - City:YALESVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1481
Mailing Address - Country:US
Mailing Address - Phone:203-284-1340
Mailing Address - Fax:203-265-4557
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2101
Practice Address - Country:US
Practice Address - Phone:203-694-8200
Practice Address - Fax:203-265-4557
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040753207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001407536Medicaid
I02741Medicare UPIN
CT001407536Medicaid
CT001407536Medicaid