Healthcare Provider Details

I. General information

NPI: 1891874376
Provider Name (Legal Business Name): PETER FRANCIS DADDARIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEWELL RD STE D21
BRISTOL CT
06010
US

IV. Provider business mailing address

25 NEWELL RD STE D21
BRISTOL CT
06010-5128
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-6944
  • Fax: 860-585-7746
Mailing address:
  • Phone: 860-585-6944
  • Fax: 860-585-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number029024
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberCT029024
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: