Healthcare Provider Details

I. General information

NPI: 1649454976
Provider Name (Legal Business Name): DUARTE G. MACHADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SOUTH MAIN STREET SUITE 102
CHESHIRE CT
06410
US

IV. Provider business mailing address

280 SOUTH MAIN STREET SUITE 102
CHESHIRE CT
06410
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-6385
  • Fax: 203-250-0191
Mailing address:
  • Phone: 203-432-0076
  • Fax: 203-432-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number047508
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: