Individual provider Active NPI

Theresa E Maldonado, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Greenwich, CT
National Provider Identifier
1861578700
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
60338 Issued in CT
Practice address
5 Perryridge Rd
Greenwich, CT 06830
Phone
(203) 863-3000
NPI assigned
Oct 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 208674 NY
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 60338 CT Primary

Addresses

Primary practice location

5 Perryridge Rd
Greenwich, CT 06830

Mailing address

102 Penn Rd
Scarsdale, NY 10583-7558
Phone (914) 713-8865

Other practice location 1

MMC - Peds. Emergency Medicine
111 E. 210th St., Silver Zone
Bronx, NY 10467
Phone (718) 920-5312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080823000096 NY Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 4587739602 Reassigns benefits to 1 organization
I20180717004120 CT Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 4587739602 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Jul 1, 2018 Accepting new patients
Yale University CurrentSince Jul 1, 2018 Accepting new patients

Locations

5 Perryridge Rd
Greenwich, CT 06830
Phone (203) 661-5330

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

789 Howard Ave
North Haven, CT 06519
Phone (203) 688-2471

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1861578700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 PENN RD",
            "city": "SCARSDALE",
            "state": "NY",
            "postal_code": "105837558",
            "telephone_number": "914-713-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PERRYRIDGE RD",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "06830",
            "telephone_number": "203-863-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "MMC - Peds. Emergency Medicine",
            "address_2": "111 E. 210th St., Silver Zone",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10467",
            "country_code": "US",
            "telephone_number": "718-920-5312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "THERESA",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2018-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "208674",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "CT",
            "license": "60338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwich, CT

Sources for this page

Verify at the official NPI Registry.